Provider Demographics
NPI:1306139290
Name:RODRIGUEZ, ENRIQUE J (RPH)
Entity type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:J
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:477 CARR 3
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-4620
Mailing Address - Country:US
Mailing Address - Phone:787-852-1330
Mailing Address - Fax:787-852-1711
Practice Address - Street 1:477 CARR #3
Practice Address - Street 2:WALGREERNS 00906
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-852-1330
Practice Address - Fax:787-852-1711
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS27759183500000X
PR3748183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist