Healthcare Provider Details

I. General information

NPI: 1750464053
Provider Name (Legal Business Name): KIRIE ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PLAZA 66 CARR 848 KM 4.2 ESQ. FLORENTINO ROMAN BO. SAN ANTON
CAROLINA PR
00983
US

IV. Provider business mailing address

PO BOX 29775
SAN JUAN PR
00929-0775
US

V. Phone/Fax

Practice location:
  • Phone: 787-768-4366
  • Fax:
Mailing address:
  • Phone: 787-768-4366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number08F2367
License Number StatePR

VIII. Authorized Official

Name: RAFAEL A RODRIGUEZ
Title or Position: OWNER
Credential:
Phone: 787-768-4366