Provider Demographics
NPI:1497308712
Name:RODRIGUEZ, LIDDA INETTE (PHR)
Entity Type:Individual
Prefix:MRS
First Name:LIDDA
Middle Name:INETTE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PHR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 441
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-0441
Mailing Address - Country:US
Mailing Address - Phone:787-632-8362
Mailing Address - Fax:787-856-0085
Practice Address - Street 1:ROAD 128 KM 3.3
Practice Address - Street 2:BO DIEGO HERNANDEZ
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698
Practice Address - Country:US
Practice Address - Phone:787-856-0023
Practice Address - Fax:787-856-0085
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004023183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist