MEDICARE: SANDRA RODRIGUEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	5578	PR

General Provider Information

NPI Number	:	1215338397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA RODRIGUEZ

Provider Business Mailing Address
First Line	:	F-16 URB. VILLA SERAL
Second Line	:
City	:	LARES
State	:	PR
Zip	:	00669-0000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 ROOSEVELT AVE
Second Line	:	WALGREENS OF SAN PATRICIO
City	:	GUAYNABO
State	:	PR
Zip	:	00968-0000
Country	:	US
Telephone Number	:	787-792-2144
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2014
Last Update Date	:	09/09/2014

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Directions to “ SANDRA RODRIGUEZ ” Practice Location

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