Provider Demographics
NPI:1043370539
Name:RODRIGUEZ, EDWIN
Entity type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:
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 1101
Mailing Address - Street 2:
Mailing Address - City:GYANICA
Mailing Address - State:PR
Mailing Address - Zip Code:00653
Mailing Address - Country:US
Mailing Address - Phone:939-640-7280
Mailing Address - Fax:
Practice Address - Street 1:CALLE JAVILLA #8
Practice Address - Street 2:FARMACIA HOSPITAL METRO POLITANO
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:787-892-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR003153183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician