Provider Demographics
NPI:1699831610
Name:RODRIGUEZ, EVELYN L
Entity Type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:L
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 1:75 CALLE MORSE
Mailing Address - Street 2:
Mailing Address - City:ARROYO
Mailing Address - State:PR
Mailing Address - Zip Code:00714-2618
Mailing Address - Country:US
Mailing Address - Phone:787-839-1769
Mailing Address - Fax:787-271-3691
Practice Address - Street 1:75 CALLE MORSE
Practice Address - Street 2:
Practice Address - City:ARROYO
Practice Address - State:PR
Practice Address - Zip Code:00714-2618
Practice Address - Country:US
Practice Address - Phone:787-839-1769
Practice Address - Fax:787-271-3691
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3959183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist