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General NPI Number Information
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NPI Number | 1174810907
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Entity Type | Individual
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Provider Name | MRS. VIMARIE RODRIGUEZ
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Gender | Female
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Dates
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Enumeration Date | 06/30/2011
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Last Update Date | 06/30/2011
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Provider Practice Location Address
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Address Line | AVE LAUREL & ALAMEDA G1 SANTA JUANITA
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City | BAYAMON
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State | PR
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Zip | 00956-6931
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Country | US
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Telephone | 787-269-4230
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Fax |
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Provider Business Mailing Address
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Address Line | CALLE 4 G4 EXT SANTA JUANITA
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City | BAYAMON
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State | PR
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Zip | 00956-5248
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Country | US
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Telephone | 787-579-4227
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 4622
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License Number State | PR
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