Provider Demographics
NPI:1457717621
Name:MERCADO, CARLIANNIE
Entity Type:Individual
Prefix:
First Name:CARLIANNIE
Middle Name:
Last Name:MERCADO
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 1:999 AVE MUNOZ RIVERA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00925-2719
Mailing Address - Country:US
Mailing Address - Phone:787-294-0407
Mailing Address - Fax:787-294-0503
Practice Address - Street 1:999 AVE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925-2719
Practice Address - Country:US
Practice Address - Phone:787-294-0407
Practice Address - Fax:787-294-0503
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10295183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician