Provider Demographics
NPI:1619008703
Name:MERCADO, JUDITH
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:
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:HC2 BOX 23102
Mailing Address - Street 2:
Mailing Address - City:AQUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603
Mailing Address - Country:US
Mailing Address - Phone:787-877-7322
Mailing Address - Fax:787-877-3342
Practice Address - Street 1:CARR 420 KM 05 BO VOLADORAS
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676-1563
Practice Address - Country:US
Practice Address - Phone:787-877-7322
Practice Address - Fax:787-877-3342
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4700183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician