Healthcare Provider Details

I. General information

NPI: 1407905326
Provider Name (Legal Business Name): PEGGY RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. EL COMANDANTE ESQ. AVENIDA CAMPO RICO
CAROLINA PR
00984-3420
US

IV. Provider business mailing address

D5 CALLE RODRIGUEZ EMMA
CAROLINA PR
00983-1811
US

V. Phone/Fax

Practice location:
  • Phone: 787-752-5111
  • Fax: 787-257-3585
Mailing address:
  • Phone: 787-768-2667
  • Fax: 787-257-3585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number2287AF
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: