Healthcare Provider Details

I. General information

NPI: 1083981989
Provider Name (Legal Business Name): CAMILO RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2011
Last Update Date: 04/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CVS DR
WOONSOCKET RI
02895-6146
US

IV. Provider business mailing address

1 CVS DR
WOONSOCKET RI
02895-6146
US

V. Phone/Fax

Practice location:
  • Phone: 800-746-7287
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRPT36775
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberRPT36775
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: