Provider Demographics
NPI:1275652695
Name:RODRIGUEZ, CLARISOL
Entity Type:Individual
Prefix:
First Name:CLARISOL
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AG36 CALLE 26
Mailing Address - Street 2:TOA ALTA HEIGHTS
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-4321
Mailing Address - Country:US
Mailing Address - Phone:787-730-8537
Mailing Address - Fax:
Practice Address - Street 1:N-15 AVE. PRINCIPAL
Practice Address - Street 2:TOA ALTA HEIGHTS
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953
Practice Address - Country:US
Practice Address - Phone:787-797-7615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2471183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician