Provider Demographics
NPI:1649351800
Name:PENA, MERCEDES LUISA
Entity type:Individual
Prefix:
First Name:MERCEDES
Middle Name:LUISA
Last Name:PENA
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:Q86 CALLE 21
Mailing Address - Street 2:BELLA VISTA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957-6110
Mailing Address - Country:US
Mailing Address - Phone:787-797-4451
Mailing Address - Fax:787-730-2255
Practice Address - Street 1:EDIFICIO 1 LOCAL 1A
Practice Address - Street 2:COMERCIAL BELLA VISTA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957
Practice Address - Country:US
Practice Address - Phone:787-797-2709
Practice Address - Fax:787-730-2255
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2888183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician