Provider Demographics
NPI:1043503931
Name:RODRIGUEZ, NELSON JUAN (RPH)
Entity type:Individual
Prefix:MR
First Name:NELSON
Middle Name:JUAN
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:NELSON
Other - Middle Name:
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:2000 AVE FELISA RINCON
Mailing Address - Street 2:APT 1203
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6648
Mailing Address - Country:US
Mailing Address - Phone:787-983-0838
Mailing Address - Fax:787-283-0566
Practice Address - Street 1:2000 AVE FELISA RINCON
Practice Address - Street 2:APT 1203
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-6648
Practice Address - Country:US
Practice Address - Phone:787-983-0838
Practice Address - Fax:787-283-0566
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2224183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist