Provider Demographics
NPI:1649708868
Name:MERCADO VAZQUEZ, JOSE RUBEN (PHARMD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:RUBEN
Last Name:MERCADO VAZQUEZ
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 CALLE LIMONERO
Mailing Address - Street 2:BEL AIR
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00971
Mailing Address - Country:US
Mailing Address - Phone:787-504-1348
Mailing Address - Fax:
Practice Address - Street 1:2114 CARR PR 2 INT CALLE MORALES
Practice Address - Street 2:CVS PHARMACY 4594
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-740-2850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-01
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6363183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist