MEDICARE: MR. JOSE ENRIQUE MELENDEZ 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	5155	PR

General Provider Information

NPI Number	:	1598020042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSE ENRIQUE MELENDEZ RPH

Provider Business Mailing Address
First Line	:	TERRAZAS PARQUE ESCORIAL 605 BLV MEDIA LUNA
Second Line	:	APT #6105
City	:	CAROLINA
State	:	PR
Zip	:	00982
Country	:	US
Telephone Number	:	787-309-8154
Fax Number	:	787-999-7205

Provider Business Practice Location Address
First Line	:	TERRAZAS DE PARQUE ESCORIAL 605 MEDIA LUNA #6105
Second Line	:
City	:	CAROLINA
State	:	PR
Zip	:	00924-1111
Country	:	US
Telephone Number	:	787-309-8154
Fax Number	:	787-999-7205

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

Provider Enumeration Date	:	07/11/2012
Last Update Date	:	07/11/2012

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