Provider Demographics
NPI:1841302973
Name:RODRIGUEZ, IVELISSE (PHARMACY TECHNICIAN)
Entity type:Individual
Prefix:MRS
First Name:IVELISSE
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CALLE 1
Mailing Address - Street 2:JARDINES DELTOA
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-1800
Mailing Address - Country:US
Mailing Address - Phone:787-400-2963
Mailing Address - Fax:
Practice Address - Street 1:1 CALLE 1
Practice Address - Street 2:JARDINES DELTOA
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-1800
Practice Address - Country:US
Practice Address - Phone:787-400-2963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1333183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician