Healthcare Provider Details

I. General information

NPI: 1780828541
Provider Name (Legal Business Name): ENIS DE JESUS MEZA-RODRIGUEZ RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2009
Last Update Date: 04/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3763 103RD ST
CORONA NY
11368-1952
US

IV. Provider business mailing address

2437 78TH ST
EAST ELMHURST NY
11370-1529
US

V. Phone/Fax

Practice location:
  • Phone: 718-205-3633
  • Fax: 718-205-5775
Mailing address:
  • Phone: 718-429-0291
  • Fax: 718-205-5775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number052268
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: