=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154547156
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. LIGIA M MELENDEZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | URB EL VEDADO COND EL CENTRO SUITE 15
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00918
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-763-5308
-----------------------------------------------------
Fax | 787-763-5312
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | AS6 CALLE 17 URBANIZACION PRADERAS
-----------------------------------------------------
City | TOA BAJA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00949-4084
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-646-2630
-----------------------------------------------------
Fax | 787-763-5312
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 003040
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------