MEDICARE: RAFAELA MENA RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	2313	PR

General Provider Information

NPI Number	:	1366641557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAFAELA MENA RPH

Provider Business Mailing Address
First Line	:	PARK CT
Second Line	:	MARACAIBO H-22
City	:	SAN JUAN
State	:	PR
Zip	:	00926-2229
Country	:	US
Telephone Number	:	787-616-0715
Fax Number	:

Provider Business Practice Location Address
First Line	:	PARK CT
Second Line	:	MARACAIBO H-22
City	:	SAN JUAN
State	:	PR
Zip	:	00926-2229
Country	:	US
Telephone Number	:	787-616-0715
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2007
Last Update Date	:	07/17/2007

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