MEDICARE: DR. JOSE ANTONIO SOTO-RODRIGUEZ PHARM.D.

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	5314	PR

General Provider Information

NPI Number	:	1265691430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE ANTONIO SOTO-RODRIGUEZ PHARM.D.

Provider Business Mailing Address
First Line	:	1051 CALLE 3 SE # VA
Second Line	:	10 CALLE CASIA
City	:	SAN JUAN
State	:	PR
Zip	:	00921-3000
Country	:	US
Telephone Number	:	787-641-7582
Fax Number	:	787-641-5714

Provider Business Practice Location Address
First Line	:	1051 CALLE 3 SE # VA
Second Line	:	10 CALLE CASIA
City	:	SAN JUAN
State	:	PR
Zip	:	00921-3000
Country	:	US
Telephone Number	:	787-641-7582
Fax Number	:	787-641-5714

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

Provider Enumeration Date	:	06/03/2008
Last Update Date	:	06/03/2008

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