Provider Demographics
NPI:1699807313
Name:ROSARIO, MERCEDES
Entity Type:Individual
Prefix:MRS
First Name:MERCEDES
Middle Name:
Last Name:ROSARIO
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 1:1854 CALLE LOIZA
Mailing Address - Street 2:
Mailing Address - City:SANTURCE
Mailing Address - State:PR
Mailing Address - Zip Code:00911-1824
Mailing Address - Country:US
Mailing Address - Phone:787-728-4471
Mailing Address - Fax:787-982-6171
Practice Address - Street 1:1854 CALLE LOIZA
Practice Address - Street 2:
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00911-1824
Practice Address - Country:US
Practice Address - Phone:787-728-4471
Practice Address - Fax:787-982-6171
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician