Basic Information
| Provider Information | |||||||||
| NPI: | 1992290712 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MELENDEZ | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | |||||||||
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| Credential: | BS PH | ||||||||
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| Mailing Information | |||||||||
| Address1: | CARLOMAGNO ST 2 F8 VILLA DEL REY | ||||||||
| Address2: | |||||||||
| City: | CAGUAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7872179294 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | CARR 14 KM 12.0 BARRIO RINCON | ||||||||
| Address2: | SECTOR LOMAS | ||||||||
| City: | CAYEY | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7875351530 | ||||||||
| FaxNumber: | 7875351103 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2018 | ||||||||
| LastUpdateDate: | 06/25/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 2242 | PR | Y | Pharmacy Service Providers | Pharmacist |
ID Information
| ID | Type | State | Issuer | Description | 1173843 | 01 | PR | DRIVER LICENSE | OTHER |