Provider Demographics
NPI:1114210077
Name:MERCADO, LOURDES (RPH)
Entity type:Individual
Prefix:
First Name:LOURDES
Middle Name:
Last Name:MERCADO
Suffix:
Gender:F
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:PO BOX 1269
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-1269
Mailing Address - Country:US
Mailing Address - Phone:787-380-9403
Mailing Address - Fax:
Practice Address - Street 1:10 CARR 149 STE DF007401
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-6204
Practice Address - Country:US
Practice Address - Phone:787-380-9403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4128183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist