Provider Demographics
NPI:1710470372
Name:RODRIGUEZ, MILTON ARIEL SR
Entity Type:Individual
Prefix:
First Name:MILTON
Middle Name:ARIEL
Last Name:RODRIGUEZ
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 CALLE SANTA CRUZ
Mailing Address - Street 2:TORRE SAN PABLO SUITE 2
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961
Mailing Address - Country:US
Mailing Address - Phone:787-620-4747
Mailing Address - Fax:787-620-9161
Practice Address - Street 1:68 CALLE SANTA CRUZ
Practice Address - Street 2:TORRE SAN PABLO SUITE 2
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-620-4747
Practice Address - Fax:787-620-9161
Is Sole Proprietor?:No
Enumeration Date:2018-06-08
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR002584183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist