Provider Demographics
NPI:1659464261
Name:MEJIAS, EVA (R PH)
Entity Type:Individual
Prefix:MRS
First Name:EVA
Middle Name:
Last Name:MEJIAS
Suffix:
Gender:F
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:#22 AVE CAMINO DEL SOL
Mailing Address - Street 2:URB. CAMINO DEL SOL
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693
Mailing Address - Country:US
Mailing Address - Phone:787-858-0999
Mailing Address - Fax:787-884-9039
Practice Address - Street 1:200 MONACO SHOPPING CTR-SUITE 1
Practice Address - Street 2:FARMACIA DEL POZA
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-854-2041
Practice Address - Fax:787-884-9039
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR002868183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4105370001Medicare ID - Type Unspecified