Provider Demographics
NPI:1477634798
Name:MARIANO RODRIGUEZ
Entity Type:Organization
Organization Name:MARIANO RODRIGUEZ
Other - Org Name:FARMACIA LUMEN MENDEZ
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIANO
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-897-2050
Mailing Address - Street 1:10 CALLE PEDRO ALBIZU CAMPOS
Mailing Address - Street 2:
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669-2434
Mailing Address - Country:US
Mailing Address - Phone:787-897-2050
Mailing Address - Fax:787-897-2778
Practice Address - Street 1:10 CALLE PEDRO ALBIZU CAMPOS
Practice Address - Street 2:
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669-2434
Practice Address - Country:US
Practice Address - Phone:787-897-2050
Practice Address - Fax:787-897-2778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR04F00553336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy