Provider Demographics
NPI:1437219706
Name:MELENDEZ, ROSA D
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:D
Last Name:MELENDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 CALLE GANGES
Mailing Address - Street 2:URB. EL PARAISO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-2917
Mailing Address - Country:US
Mailing Address - Phone:787-763-3556
Mailing Address - Fax:
Practice Address - Street 1:BB1 AVE FLOR DEL VALLE
Practice Address - Street 2:URB. LAS VEGAS
Practice Address - City:CATANO
Practice Address - State:PR
Practice Address - Zip Code:00962-6436
Practice Address - Country:US
Practice Address - Phone:787-788-8414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2111183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist