Provider Demographics
NPI:1689027393
Name:MERCADO-PEREZ, ANGELIQUE
Entity Type:Individual
Prefix:
First Name:ANGELIQUE
Middle Name:
Last Name:MERCADO-PEREZ
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 1:232 CALLE LAS PALMAS
Mailing Address - Street 2:LA COSTA APTS.
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-5144
Mailing Address - Country:US
Mailing Address - Phone:787-914-8148
Mailing Address - Fax:
Practice Address - Street 1:232 CALLE LAS PALMAS
Practice Address - Street 2:LA COSTA APTS.
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-5144
Practice Address - Country:US
Practice Address - Phone:787-914-8148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR02416183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist