Provider Demographics
NPI:1255513727
Name:RODA, LINA M (R PH)
Entity type:Individual
Prefix:
First Name:LINA
Middle Name:M
Last Name:RODA
Suffix:
Gender:F
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 CALLE TOUS SOTO
Mailing Address - Street 2:BALDRICH
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-4312
Mailing Address - Country:US
Mailing Address - Phone:787-466-9904
Mailing Address - Fax:
Practice Address - Street 1:550 CALLE SERGIO CUEVAS
Practice Address - Street 2:HOSPITAL DEL MAESTRO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2683
Practice Address - Country:US
Practice Address - Phone:787-758-8383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2630183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist