Provider Demographics
NPI:1659586030
Name:MELENDEZ, NILDA LUZ
Entity Type:Individual
Prefix:
First Name:NILDA
Middle Name:LUZ
Last Name:MELENDEZ
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:PO BOX 2021
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-2021
Mailing Address - Country:US
Mailing Address - Phone:787-735-3025
Mailing Address - Fax:787-735-2725
Practice Address - Street 1:SAN JOSE ST.#300
Practice Address - Street 2:
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705-2021
Practice Address - Country:US
Practice Address - Phone:787-735-3025
Practice Address - Fax:787-735-2725
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2645183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician