Provider Demographics
NPI:1013037175
Name:ROLDAN MUNOZ, ROBERTO (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:ROLDAN MUNOZ
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE 8 NUM 235
Mailing Address - Street 2:VEREDAS DE LAS PALMAS
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778
Mailing Address - Country:US
Mailing Address - Phone:787-747-3451
Mailing Address - Fax:787-737-1242
Practice Address - Street 1:CARRETERA 941
Practice Address - Street 2:SALIDA BARRIO JAGUAS
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778
Practice Address - Country:US
Practice Address - Phone:787-737-4449
Practice Address - Fax:787-737-1242
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4226183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4226OtherLICENCE PHARMACIST