Provider Demographics
NPI:1528811650
Name:CINTRON MERCADO, EDWARD JAVIER
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:JAVIER
Last Name:CINTRON MERCADO
Suffix:
Gender:M
Credentials:
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 1128
Mailing Address - Street 2:
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667-1128
Mailing Address - Country:US
Mailing Address - Phone:787-423-9245
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1128
Practice Address - Street 2:
Practice Address - City:LAJAS
Practice Address - State:PR
Practice Address - Zip Code:00667-1128
Practice Address - Country:US
Practice Address - Phone:787-423-9245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-09
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1528811650390200000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program