Provider Demographics
NPI:1992929848
Name:RODRIGUEZ, NYDIA IVELLISSE
Entity type:Individual
Prefix:MRS
First Name:NYDIA
Middle Name:IVELLISSE
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:CALLE HIRAM BITHORN #238
Mailing Address - Street 2:URB ORIENTE
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771
Mailing Address - Country:US
Mailing Address - Phone:787-716-6639
Mailing Address - Fax:
Practice Address - Street 1:CALLE RUIZ BELVIS #47
Practice Address - Street 2:FARMACIA RIMARI
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-744-1441
Practice Address - Fax:787-258-8223
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3548183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician