Provider Demographics
NPI:1588958383
Name:MELENDEZ, ANA
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:MELENDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PALMA REAL # 128, C. JARDIN 3
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953
Mailing Address - Country:US
Mailing Address - Phone:787-730-1661
Mailing Address - Fax:787-730-1661
Practice Address - Street 1:128 CALLE PALMA REAL
Practice Address - Street 2:C. JARDIN 3
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-4819
Practice Address - Country:US
Practice Address - Phone:787-730-1661
Practice Address - Fax:787-730-1661
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5462183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist