Provider Demographics
NPI:1033405444
Name:RODRIGUEZ, CARMEN I
Entity Type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:I
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:I
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:6 PASEO DEL PARQUE
Mailing Address - Street 2:
Mailing Address - City:BARCELONETA
Mailing Address - State:PR
Mailing Address - Zip Code:00617-2902
Mailing Address - Country:US
Mailing Address - Phone:787-746-6829
Mailing Address - Fax:787-846-7351
Practice Address - Street 1:6 PASEO DEL PARQUE
Practice Address - Street 2:
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617-2902
Practice Address - Country:US
Practice Address - Phone:787-746-6829
Practice Address - Fax:787-846-7351
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2906183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist