Provider Demographics
NPI:1881745685
Name:MELENDEZ, IVELISSE
Entity type:Individual
Prefix:
First Name:IVELISSE
Middle Name:
Last Name:MELENDEZ
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:HC-01 BOX 7052
Mailing Address - Street 2:
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783
Mailing Address - Country:US
Mailing Address - Phone:787-782-8747
Mailing Address - Fax:787-783-6020
Practice Address - Street 1:19-22 AVE. RAMIREZ DE ARELLANO SUITE #1
Practice Address - Street 2:CENTRO COMERCIAL TORRIMAR
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966-3175
Practice Address - Country:US
Practice Address - Phone:787-782-8747
Practice Address - Fax:787-783-6020
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5100183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician