Provider Demographics
NPI:1699378950
Name:MENGOA ALVAREZ, RALPH JUNIOR
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:JUNIOR
Last Name:MENGOA ALVAREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 LOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01832-3683
Mailing Address - Country:US
Mailing Address - Phone:978-373-1234
Mailing Address - Fax:
Practice Address - Street 1:425 LOWELL AVE
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01832-3683
Practice Address - Country:US
Practice Address - Phone:978-373-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH232975183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist