MEDICARE: SACHETTE M RODRIGUEZ CPHT

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	183700000X	Pharmacy Technician	011870	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	011870	OTHER	PR	LICENSE

General Provider Information

NPI Number	:	1780116467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SACHETTE M RODRIGUEZ CPHT

Provider Business Mailing Address
First Line	:	Q10 CALLE 15
Second Line	:	EL MADRIGAL
City	:	PONCE
State	:	PR
Zip	:	00730-1444
Country	:	US
Telephone Number	:	787-236-6496
Fax Number	:

Provider Business Practice Location Address
First Line	:	Q10 CALLE 15
Second Line	:	EL MADRIGAL
City	:	PONCE
State	:	PR
Zip	:	00730-1444
Country	:	US
Telephone Number	:	787-236-6496
Fax Number	:

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

Provider Enumeration Date	:	03/31/2017
Last Update Date	:	03/31/2017

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