Provider Demographics
NPI:1659366656
Name:RODRIGUEZ, VIXMA IVELDA (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:VIXMA
Middle Name:IVELDA
Last Name: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:PO BOX 1305
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-1305
Mailing Address - Country:US
Mailing Address - Phone:787-856-0023
Mailing Address - Fax:787-856-0085
Practice Address - Street 1:ST ROAD 128 KM 3.3
Practice Address - Street 2:BO DIEGO HERNANDEZ
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698-1305
Practice Address - Country:US
Practice Address - Phone:787-856-0023
Practice Address - Fax:787-856-0085
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3376183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist