Provider Demographics
NPI:1063988368
Name:MERCADO, ANGEL (RPH)
Entity type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:
Last Name:MERCADO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11940 GARVEY AVE
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91732-3514
Mailing Address - Country:US
Mailing Address - Phone:626-350-1052
Mailing Address - Fax:626-350-8122
Practice Address - Street 1:11940 GARVEY AVE
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91732-3514
Practice Address - Country:US
Practice Address - Phone:626-350-1052
Practice Address - Fax:626-350-8122
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79053183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA79053OtherCALIFORNIA BOARD OF PHARMACY