Provider Demographics
NPI:1316674773
Name:BARRERA, PAMELA MERCEDES (RPH)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:MERCEDES
Last Name:BARRERA
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 1:390 LAKE AVE # B
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-2629
Mailing Address - Country:US
Mailing Address - Phone:732-570-8433
Mailing Address - Fax:
Practice Address - Street 1:5313 5TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3110
Practice Address - Country:US
Practice Address - Phone:732-570-8433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025460333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy