Provider Demographics
NPI:1053393264
Name:IZAGAS, MERCEDES I (RPH)
Entity type:Individual
Prefix:MRS
First Name:MERCEDES
Middle Name:I
Last Name:IZAGAS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. LA CUMBRE 497
Mailing Address - Street 2:AVENUE EMILIANO POL SUITE 347
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-272-4101
Mailing Address - Fax:787-283-3673
Practice Address - Street 1:CARR. 176 ESQ. AVE SAN CLAUDIO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-272-4101
Practice Address - Fax:787-283-3673
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4306183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist