Provider Demographics
NPI:1235253089
Name:RODRIGUEZ, MAYRA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MAYRA
Middle Name:
Last Name:RODRIGUEZ
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:C ALLE# 2 C9 STA PAULA
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-993-1713
Mailing Address - Fax:
Practice Address - Street 1:57 CALLE BARBOSA
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6350
Practice Address - Country:US
Practice Address - Phone:787-620-9603
Practice Address - Fax:787-785-2387
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2836183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist