Provider Demographics
NPI:1902929672
Name:RODRIGUEZ, DENISSE J (RPH)
Entity type:Individual
Prefix:MRS
First Name:DENISSE
Middle Name:J
Last Name:RODRIGUEZ
Suffix:
Gender:F
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:PO BOX 83
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-0083
Mailing Address - Country:US
Mailing Address - Phone:787-856-4966
Mailing Address - Fax:787-856-4966
Practice Address - Street 1:200 BARINAS SHOPPING CENTER
Practice Address - Street 2:SUITE 203
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698-2712
Practice Address - Country:US
Practice Address - Phone:787-856-4966
Practice Address - Fax:787-856-4966
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4004183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist