Healthcare Provider Details

I. General information

NPI: 1710470372
Provider Name (Legal Business Name): MILTON ARIEL RODRIGUEZ SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2018
Last Update Date: 06/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 CALLE SANTA CRUZ TORRE SAN PABLO SUITE 2
BAYAMON PR
00961
US

IV. Provider business mailing address

68 CALLE SANTA CRUZ TORRE SAN PABLO SUITE 2
BAYAMON PR
00961
US

V. Phone/Fax

Practice location:
  • Phone: 787-620-4747
  • Fax: 787-620-9161
Mailing address:
  • Phone: 787-620-4747
  • Fax: 787-620-9161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number002584
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: