Healthcare Provider Details

I. General information

NPI: 1588168363
Provider Name (Legal Business Name): LUZ M ROSENDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CVS PHARMACY STORE 4588 6109 CARR 694
VEGA ALTA PR
00692
US

IV. Provider business mailing address

CVS PHARMACY STORE 4588 6109 CARR 694
VEGA ALTA PR
00692
US

V. Phone/Fax

Practice location:
  • Phone: 787-270-0460
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2180
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: