Provider Demographics
NPI:1467541573
Name:MELECIO, JERRY (PHARM AUX)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:MELECIO
Suffix:
Gender:M
Credentials:PHARM AUX
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 142
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-0142
Mailing Address - Country:US
Mailing Address - Phone:787-796-4329
Mailing Address - Fax:
Practice Address - Street 1:CALLE #4 H-17
Practice Address - Street 2:JARDINES DE DORADO
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-0142
Practice Address - Country:US
Practice Address - Phone:787-796-4329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1978183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1576933OtherDRIVERS LICENCE