Provider Demographics
NPI:1306202395
Name:RODRIGUEZ, DANITZA KEISHLA (PHARMD)
Entity Type:Individual
Prefix:
First Name:DANITZA
Middle Name:KEISHLA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LAUREL & ALAMEDA G1
Mailing Address - Street 2:AVENIDA LAUREL
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956
Mailing Address - Country:US
Mailing Address - Phone:787-269-4250
Mailing Address - Fax:
Practice Address - Street 1:432 CALLE TANAMA
Practice Address - Street 2:PALACIOS DEL RIO 1
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-5003
Practice Address - Country:US
Practice Address - Phone:787-461-1032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-07
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6372183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist