Provider Demographics
NPI:1801326541
Name:RODRIGUEZ, EDELMIRO (PHARM D)
Entity type:Individual
Prefix:DR
First Name:EDELMIRO
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51877
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00950-1877
Mailing Address - Country:US
Mailing Address - Phone:787-455-2345
Mailing Address - Fax:
Practice Address - Street 1:105 GILBERTO CONCEPCION DE GRACIA
Practice Address - Street 2:CVS HEALTH
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-725-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-15
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6197183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6197OtherPHARMACIST LICENSE NUMBER