Provider Demographics
NPI:1871772061
Name:RODRIGUEZ, IVONNE (RPH)
Entity type:Individual
Prefix:
First Name:IVONNE
Middle Name:
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 1:145 AVE HOSTOS
Mailing Address - Street 2:MONTESUR TOWN HOUSES G 911
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-4258
Mailing Address - Country:US
Mailing Address - Phone:787-189-2554
Mailing Address - Fax:
Practice Address - Street 1:COND AMERICAS
Practice Address - Street 2:#400 VILLA NEVARES
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2152
Practice Address - Country:US
Practice Address - Phone:787-751-5656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3521183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist