Healthcare Provider Details

I. General information

NPI: 1043207954
Provider Name (Legal Business Name): CARLOS A MENDEZ PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CALLE CASIA VA MEDICAL CENTER, PHARMACY SERVICE (119)
SAN JUAN PR
00921-3200
US

IV. Provider business mailing address

302 CAMINO DE LAS PALMAS URB. SABANERA DEL RIO
GURABO PR
00778-5245
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-7585
  • Fax:
Mailing address:
  • Phone: 787-641-7582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4298
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: