Provider Demographics
NPI:1629537501
Name:RODRIGUEZ RODRIGUEZ, KRYSTAL EDUARIS (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:EDUARIS
Last Name:RODRIGUEZ RODRIGUEZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 GRAND BLVD LOS PRADOS STE 785
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-9533
Mailing Address - Country:US
Mailing Address - Phone:787-415-9846
Mailing Address - Fax:
Practice Address - Street 1:200 GRAND BLVD LOS PRADOS STE 785
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727-9533
Practice Address - Country:US
Practice Address - Phone:787-415-9846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS58831183500000X
PR6632183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist