MEDICARE: LINA M RODA R PH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	2630	PR

General Provider Information

NPI Number	:	1255513727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINA M RODA R PH

Provider Business Mailing Address
First Line	:	213 CALLE TOUS SOTO
Second Line	:	BALDRICH
City	:	SAN JUAN
State	:	PR
Zip	:	00918-4312
Country	:	US
Telephone Number	:	787-466-9904
Fax Number	:

Provider Business Practice Location Address
First Line	:	550 CALLE SERGIO CUEVAS
Second Line	:	HOSPITAL DEL MAESTRO
City	:	SAN JUAN
State	:	PR
Zip	:	00918-2683
Country	:	US
Telephone Number	:	787-758-8383
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/27/2007
Last Update Date	:	11/27/2007

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