Healthcare Provider Details

I. General information

NPI: 1467541573
Provider Name (Legal Business Name): JERRY MELECIO PHARM AUX
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE #4 H-17 JARDINES DE DORADO
DORADO PR
00646-0142
US

IV. Provider business mailing address

PO BOX 142
DORADO PR
00646-0142
US

V. Phone/Fax

Practice location:
  • Phone: 787-796-4329
  • Fax:
Mailing address:
  • Phone: 787-796-4329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number1978
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: