Provider Demographics
NPI:1851309132
Name:MERCADO, REINALDO (MBA, RPH)
Entity Type:Individual
Prefix:MR
First Name:REINALDO
Middle Name:
Last Name:MERCADO
Suffix:
Gender:M
Credentials:MBA, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5705 STERLING OAKS DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8271
Mailing Address - Country:US
Mailing Address - Phone:615-327-4751
Mailing Address - Fax:615-321-6310
Practice Address - Street 1:1310 24TH AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-2637
Practice Address - Country:US
Practice Address - Phone:615-347-4751
Practice Address - Fax:615-321-6310
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24615183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1OtherAN INDIVIDUAL WHO RENDERS