1578692869 NPI number — MRS. WILDAMARY RODRIGUEZ PHARMACY TECH

Table of content: MRS. WILDAMARY RODRIGUEZ PHARMACY TECH (NPI 1578692869)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578692869 NPI number — MRS. WILDAMARY RODRIGUEZ PHARMACY TECH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODRIGUEZ
Provider First Name:
WILDAMARY
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHARMACY TECH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578692869
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 CALLE NOYA HERNANDEZ E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUMACAO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00791-4142
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-285-4055
Provider Business Mailing Address Fax Number:
787-285-4055

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
STREET NOYA AND HERHANDEZ #2
Provider Second Line Business Practice Location Address:
FARMACIA MARISEL I
Provider Business Practice Location Address City Name:
HUMACAO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00792
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-852-4180
Provider Business Practice Location Address Fax Number:
787-285-4055
Provider Enumeration Date:
03/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183700000X , with the licence number:  4971 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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