=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023050697
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALEIDA L. RODRIGUEZ MIRAND & FARMACI
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2006
-----------------------------------------------------
Last Update Date | 07/18/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 37 CALLE BETANCES
-----------------------------------------------------
City | VEGA BAJA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00693-4464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-858-2280
-----------------------------------------------------
Fax | 787-828-2280
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 37 CALLE BETANCES
-----------------------------------------------------
City | VEGA BAJA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00693-4464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-858-2280
-----------------------------------------------------
Fax | 787-828-2280
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ALEIDA RODRIGUEZ
-----------------------------------------------------
Credential | PHARMACIST
-----------------------------------------------------
Telephone | 787-858-2280
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 17F1295
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------