=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871772061
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | IVONNE RODRIGUEZ RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2007
-----------------------------------------------------
Last Update Date | 10/24/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | COND AMERICAS #400 VILLA NEVARES
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00909-2152
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-751-5656
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 145 AVE HOSTOS MONTESUR TOWN HOUSES G 911
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00918-4258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-189-2554
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 3521
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------