Provider Demographics
NPI:1699812792
Name:RODRIGUEZ, INGRID G (RPH)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:G
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:RPH
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 2040
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-2040
Mailing Address - Country:US
Mailing Address - Phone:787-864-7669
Mailing Address - Fax:787-824-8888
Practice Address - Street 1:MUNOZ RIVERA ST
Practice Address - Street 2:33
Practice Address - City:SALINAS
Practice Address - State:PR
Practice Address - Zip Code:00751
Practice Address - Country:US
Practice Address - Phone:787-824-7777
Practice Address - Fax:787-824-8888
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist