Healthcare Provider Details

I. General information

NPI: 1750205449
Provider Name (Legal Business Name): JORGE A RODRIGUEZ LOPEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 CALLE IGUALDAD
FAJARDO PR
00738
US

IV. Provider business mailing address

412 CALLE FLAMBOYAN
HUMACAO PR
00791-4907
US

V. Phone/Fax

Practice location:
  • Phone: 787-863-1880
  • Fax: 787-860-6464
Mailing address:
  • Phone: 787-396-8233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number008674
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: