Provider Demographics
NPI:1174807416
Name:MERCADO, EDWIN S (RPH)
Entity type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:S
Last Name:MERCADO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PMB 235 CALLE 39 UU1
Mailing Address - Street 2:SANTA JUANITA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956
Mailing Address - Country:US
Mailing Address - Phone:787-785-9191
Mailing Address - Fax:787-785-9223
Practice Address - Street 1:WALGREENS ST710 CARR#2
Practice Address - Street 2:SUITE 01 DRIVE-INN PLAZA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-785-9191
Practice Address - Fax:787-785-9223
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR3945183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist