Provider Demographics
NPI:1609357920
Name:RODRIGUEZ, MONICA LIZ
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:LIZ
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:TORRE MEDICA 2 DR PEDRO BLANCO LUGO
Mailing Address - Street 2:200 CARR 2 SUITE 2-51
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674
Mailing Address - Country:US
Mailing Address - Phone:787-507-3644
Mailing Address - Fax:787-680-0844
Practice Address - Street 1:TORRE MEDICA 2 DR PEDRO BLANCO LUGO
Practice Address - Street 2:200 CARR 2 SUITE 2-51
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-507-3644
Practice Address - Fax:787-680-0844
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy