Provider Demographics
NPI:1568049146
Name:MERCADO, LORIS MARIE
Entity Type:Individual
Prefix:
First Name:LORIS
Middle Name:MARIE
Last Name:MERCADO
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 1:2511 PONCE BYP
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1305
Mailing Address - Country:US
Mailing Address - Phone:787-284-2500
Mailing Address - Fax:787-284-2509
Practice Address - Street 1:2511 PONCE BYP
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1305
Practice Address - Country:US
Practice Address - Phone:787-284-2500
Practice Address - Fax:787-284-2509
Is Sole Proprietor?:No
Enumeration Date:2021-03-28
Last Update Date:2021-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10488183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician