Provider Demographics
NPI:1407975691
Name:RODRIGUEZ, LOURDES DENNISSE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:LOURDES
Middle Name:DENNISSE
Last Name:RODRIGUEZ
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 1:2511 CALLE PAJUIL
Mailing Address - Street 2:URB LOS CAOBOS
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-2721
Mailing Address - Country:US
Mailing Address - Phone:787-984-0454
Mailing Address - Fax:
Practice Address - Street 1:108 CALLE VICTORIA
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-3767
Practice Address - Country:US
Practice Address - Phone:787-267-2007
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
PR3479183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist