Provider Demographics
NPI:1871808444
Name:RODRIGUEZ, MAYRA (RPH, PHARMD)
Entity type:Individual
Prefix:MS
First Name:MAYRA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BAY CLUB DR
Mailing Address - Street 2:APT. 21Z2
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-2917
Mailing Address - Country:US
Mailing Address - Phone:718-281-9892
Mailing Address - Fax:
Practice Address - Street 1:75 NASSAU TERMINAL RD
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-4927
Practice Address - Country:US
Practice Address - Phone:516-280-1000
Practice Address - Fax:516-280-1074
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-08
Last Update Date:2010-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038890183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist