Basic Information
Provider Information | |||||||||
NPI: | 1699099770 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | VELEZ MERCADO | ||||||||
FirstName: | MEREDITH | ||||||||
MiddleName: | MARIE | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PHARM.D., BCPS | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 336810 | ||||||||
Address2: | HOSPITAL EPISCOPAL SAN LUCAS | ||||||||
City: | PONCE | ||||||||
State: | PR | ||||||||
PostalCode: | 007336810 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7878442080 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 917 AVE TITO CASTRO | ||||||||
Address2: |   | ||||||||
City: | PONCE | ||||||||
State: | PR | ||||||||
PostalCode: | 007164717 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7878442080 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/18/2010 | ||||||||
LastUpdateDate: | 07/22/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P0018X | 5431 | PR | Y |   | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P1200X | 5431 | PR | N |   | Pharmacy Service Providers | Pharmacist | Pharmacotherapy | 1835P1200X | 52855 | TX | N |   | Pharmacy Service Providers | Pharmacist | Pharmacotherapy |
No ID Information.