Provider Demographics
NPI:1518649896
Name:KERCADO, EILEEN
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:KERCADO
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:CALLE HABANA L 548 EXT FOREST HILL
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-8715
Mailing Address - Country:US
Mailing Address - Phone:939-349-6958
Mailing Address - Fax:
Practice Address - Street 1:SAN JUAN HEALTH CENTER
Practice Address - Street 2:150 AVE DE DIEGO PRIMER PISO
Practice Address - City:SAN JUAN PR
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-725-8073
Practice Address - Fax:787-725-1721
Is Sole Proprietor?:No
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR009753183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician