Provider Demographics
NPI:1912543745
Name:ROLDAN, MIGDALIA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MIGDALIA
Middle Name:
Last Name:ROLDAN
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:CALLE GRAN AUSUBO 446
Mailing Address - Street 2:CIUDAD JARDIN III
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953
Mailing Address - Country:US
Mailing Address - Phone:787-645-2917
Mailing Address - Fax:
Practice Address - Street 1:CARR 862 KM 1.9
Practice Address - Street 2:HATO TEJAS
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00958
Practice Address - Country:US
Practice Address - Phone:787-269-3140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2385183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist