MEDICARE: MRS. JESSICA MARIE RODRIGUEZ RPH

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	333600000X	Pharmacy	16F2893	PR

General Provider Information

NPI Number	:	1417509670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA MARIE RODRIGUEZ RPH

Provider Business Mailing Address
First Line	:	141 CALLE CUARZO # B11
Second Line	:
City	:	RIO GRANDE
State	:	PR
Zip	:	00745-4375
Country	:	US
Telephone Number	:	787-529-7273
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 AVE LAGUNA
Second Line	:	LAGUNA GARDEN SHP CTR. #115
City	:	CAROLINA
State	:	PR
Zip	:	00979-6400
Country	:	US
Telephone Number	:	787-791-2065
Fax Number	:	787-253-1002

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

Provider Enumeration Date	:	07/09/2019
Last Update Date	:	07/09/2019

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