Provider Demographics
NPI:1215338397
Name:RODRIGUEZ, SANDRA
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:F-16 URB. VILLA SERAL
Mailing Address - Street 2:
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669-0000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 ROOSEVELT AVE
Practice Address - Street 2:WALGREENS OF SAN PATRICIO
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968-0000
Practice Address - Country:US
Practice Address - Phone:787-792-2144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5578183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist