Provider Demographics
NPI:1508439589
Name:RODRIGUEZ-DIAZ, JAN KARLO (PHARMD)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:KARLO
Last Name:RODRIGUEZ-DIAZ
Suffix:
Gender:M
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:VILLA DEL CARMEN 2933 SALOU
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-2247
Mailing Address - Country:US
Mailing Address - Phone:787-969-2463
Mailing Address - Fax:
Practice Address - Street 1:2 CARR 140
Practice Address - Street 2:
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617-2261
Practice Address - Country:US
Practice Address - Phone:787-846-6829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6882183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist