Provider Demographics
NPI:1174693956
Name:RODRIGUEZ, NOEMI
Entity type:Individual
Prefix:MRS
First Name:NOEMI
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:453 VIA NIZA
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-4644
Mailing Address - Country:US
Mailing Address - Phone:787-245-2412
Mailing Address - Fax:787-871-1593
Practice Address - Street 1:453 VIA NIZA
Practice Address - Street 2:
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-4644
Practice Address - Country:US
Practice Address - Phone:787-245-2412
Practice Address - Fax:787-871-1593
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR140183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1740OtherPHARMACIST