Provider Demographics
NPI:1992471486
Name:MONGE, MARLENE (PHARMACIST)
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:
Last Name:MONGE
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:839 LEOPARD TRL
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-4127
Mailing Address - Country:US
Mailing Address - Phone:407-312-4352
Mailing Address - Fax:
Practice Address - Street 1:CARR. 151 KM. 0.4 URB. LA VEGA
Practice Address - Street 2:
Practice Address - City:VILLALBA
Practice Address - State:PR
Practice Address - Zip Code:00766
Practice Address - Country:US
Practice Address - Phone:787-847-5309
Practice Address - Fax:787-847-5307
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR002092183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist