Provider Demographics
NPI:1598304883
Name:RODRIGUEZ, CARMEN ENILDA
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:ENILDA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237-21 CALLE 615
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985-2231
Mailing Address - Country:US
Mailing Address - Phone:787-752-9644
Mailing Address - Fax:787-257-0770
Practice Address - Street 1:237-21 CALLE 615
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-2231
Practice Address - Country:US
Practice Address - Phone:787-752-9644
Practice Address - Fax:787-257-0770
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-03
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2056183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty