Provider Demographics
NPI:1649924218
Name:RODRIGUEZ CEPEDA, CARLOS ELADIO (RPH)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:ELADIO
Last Name:RODRIGUEZ CEPEDA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 E 105TH ST APT 5D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-8503
Mailing Address - Country:US
Mailing Address - Phone:646-719-6058
Mailing Address - Fax:
Practice Address - Street 1:3 E 115TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-1088
Practice Address - Country:US
Practice Address - Phone:212-722-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY068698183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist