Provider Demographics
NPI:1053078246
Name:MERCADO MENDEZ, CARLOS RAFAEL (PHARMD)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:RAFAEL
Last Name:MERCADO MENDEZ
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 MUNOZ RIVERA
Mailing Address - Street 2:COND AQUABLUE APT PH4
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-298-4018
Mailing Address - Fax:
Practice Address - Street 1:CARR PR 3 KM 85.9
Practice Address - Street 2:BO CANDELERO
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-850-8011
Practice Address - Fax:787-850-5605
Is Sole Proprietor?:No
Enumeration Date:2021-11-22
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6916183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist