Healthcare Provider Details

I. General information

NPI: 1700488640
Provider Name (Legal Business Name): CORALYS ANDREA MELENDEZ TUR PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2020
Last Update Date: 11/16/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VILLA CAPARRA 178 CARR2
GUAYNABO PR
00966
US

IV. Provider business mailing address

URB. PRADERA ALMIRA AJ6 CALLE 6
TOA BAJA PR
00949
US

V. Phone/Fax

Practice location:
  • Phone: 787-706-3600
  • Fax:
Mailing address:
  • Phone: 787-420-1661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6801
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: