Provider Demographics
NPI:1982991956
Name:MERCED, SANDRA YOLANDA (PH)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:YOLANDA
Last Name:MERCED
Suffix:
Gender:F
Credentials:PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1498 AVE FD ROOSEVELT STE 1
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968-2735
Mailing Address - Country:US
Mailing Address - Phone:787-792-3725
Mailing Address - Fax:787-774-0555
Practice Address - Street 1:1 ROOSEVELT AVE.
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968
Practice Address - Country:US
Practice Address - Phone:787-792-3725
Practice Address - Fax:787-774-0555
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3870183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist