Provider Demographics
NPI:1952441636
Name:AIDA I RODRIGUEZ NOBLE
Entity Type:Organization
Organization Name:AIDA I RODRIGUEZ NOBLE
Other - Org Name:FARMACIA DEL VALENCIANO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST,OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AIDA
Authorized Official - Middle Name:I
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-734-7622
Mailing Address - Street 1:PO BOX 1599
Mailing Address - Street 2:
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-1599
Mailing Address - Country:US
Mailing Address - Phone:787-734-7622
Mailing Address - Fax:787-713-5692
Practice Address - Street 1:11 CARR 31
Practice Address - Street 2:
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777-3894
Practice Address - Country:US
Practice Address - Phone:787-734-7622
Practice Address - Fax:787-713-5692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07-F-22863336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5604670001Medicare NSC