Provider Demographics
NPI:1164197901
Name:RODRIGUEZ LOPEZ, KEISHLA MARIE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:KEISHLA
Middle Name:MARIE
Last Name:RODRIGUEZ LOPEZ
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 2 BOX 7883
Mailing Address - Street 2:
Mailing Address - City:HORMIGUEROS
Mailing Address - State:PR
Mailing Address - Zip Code:00660-9723
Mailing Address - Country:US
Mailing Address - Phone:787-215-7074
Mailing Address - Fax:
Practice Address - Street 1:CARR 346 KM 0.5 INT
Practice Address - Street 2:BO JAGUITAS SECT PLAMBONITO
Practice Address - City:HORMIGUEROS
Practice Address - State:PR
Practice Address - Zip Code:00660
Practice Address - Country:US
Practice Address - Phone:787-215-7074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6741183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist