Provider Demographics
NPI:1992290712
Name:MELENDEZ, SANDRA (BS PH)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:MELENDEZ
Suffix:
Gender:F
Credentials:BS PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARLOMAGNO ST 2 F8 VILLA DEL REY
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-217-9294
Mailing Address - Fax:
Practice Address - Street 1:CARR 14 KM 12.0 BARRIO RINCON
Practice Address - Street 2:SECTOR LOMAS
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736
Practice Address - Country:US
Practice Address - Phone:787-535-1530
Practice Address - Fax:787-535-1103
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2242183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1173843OtherDRIVER LICENSE