Healthcare Provider Details

I. General information

NPI: 1720529738
Provider Name (Legal Business Name): MELVIN MARCANO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2017
Last Update Date: 03/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 CALLE CHRISTMAS FORT BUCHANAN
GUAYNABO PR
00920
US

IV. Provider business mailing address

9 CALLE FAJARDO BONNEVILLE HEIGHTS
CAGUAS PR
00727-4952
US

V. Phone/Fax

Practice location:
  • Phone: 787-707-2858
  • Fax:
Mailing address:
  • Phone: 787-944-9417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number010691
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: