Provider Demographics
NPI:1639249725
Name:NIEVES-RODRIGUEZ, YSARIS (PHARM D)
Entity Type:Individual
Prefix:
First Name:YSARIS
Middle Name:
Last Name:NIEVES-RODRIGUEZ
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 2 BOX 6224
Mailing Address - Street 2:
Mailing Address - City:PENUELAS
Mailing Address - State:PR
Mailing Address - Zip Code:00624-9609
Mailing Address - Country:US
Mailing Address - Phone:787-615-3773
Mailing Address - Fax:787-836-5231
Practice Address - Street 1:HC 2 BOX 6224
Practice Address - Street 2:
Practice Address - City:PENUELAS
Practice Address - State:PR
Practice Address - Zip Code:00624-9609
Practice Address - Country:US
Practice Address - Phone:787-615-3773
Practice Address - Fax:787-836-5231
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5208183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist