Provider Demographics
NPI:1417509670
Name:RODRIGUEZ, JESSICA MARIE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:MARIE
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 1:141 CALLE CUARZO # B11
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-4375
Mailing Address - Country:US
Mailing Address - Phone:787-529-7273
Mailing Address - Fax:
Practice Address - Street 1:10 AVE LAGUNA
Practice Address - Street 2:LAGUNA GARDEN SHP CTR. #115
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979-6400
Practice Address - Country:US
Practice Address - Phone:787-791-2065
Practice Address - Fax:787-253-1002
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16F2893333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy