Provider Demographics
NPI:1023170685
Name:MENCHACA, MARISEL (RPH)
Entity type:Individual
Prefix:
First Name:MARISEL
Middle Name:
Last Name:MENCHACA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8567
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-8567
Mailing Address - Country:US
Mailing Address - Phone:787-850-9246
Mailing Address - Fax:787-850-5600
Practice Address - Street 1:AVE. FONT MARTELO # 124E
Practice Address - Street 2:ESQ. ANTONIO LOPEZ
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-850-9246
Practice Address - Fax:787-850-5600
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2202183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist