=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356684955
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIE A MELENDEZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2013
-----------------------------------------------------
Last Update Date | 04/02/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CARR. 19 KM 1.0 CENTRO COMERCIAL GARDEN HILLS 1379
-----------------------------------------------------
City | GUAYNABO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00966
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-620-9616
-----------------------------------------------------
Fax | 787-749-9435
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | RR 3 BOX 10430
-----------------------------------------------------
City | TOA ALTA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00953-8028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-310-7690
-----------------------------------------------------
Fax | 787-749-9435
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183700000X
-----------------------------------------------------
Taxonomy Name | Pharmacy Technician
-----------------------------------------------------
License Number | 6883
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------