Provider Demographics
NPI:1679774624
Name:MELENDEZ, MIRIAM HAYDEE
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:HAYDEE
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:PMB 587 HC-01
Mailing Address - Street 2:BOX 29030
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-8900
Mailing Address - Country:US
Mailing Address - Phone:787-747-3116
Mailing Address - Fax:
Practice Address - Street 1:BAXTER PHARMACY
Practice Address - Street 2:SECTOR BECHARA BUCHANAM
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00936
Practice Address - Country:US
Practice Address - Phone:787-792-7550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR25471835N1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N1003XPharmacy Service ProvidersPharmacistNutrition Support
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2547OtherPHARMACIST LICENSE