Provider Demographics
NPI:1053447300
Name:RODRIGUEZ, GLORIANA
Entity type:Individual
Prefix:
First Name:GLORIANA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE ALMENDRO #110 LOS COLOBOS
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987
Mailing Address - Country:US
Mailing Address - Phone:787-762-5805
Mailing Address - Fax:787-752-0140
Practice Address - Street 1:CALLE 1 AVE A CENTRO COMERCIAL METROPOLIS
Practice Address - Street 2:SUPER FARMACIA METROPOLIS
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987
Practice Address - Country:US
Practice Address - Phone:787-762-5805
Practice Address - Fax:787-752-0140
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2381183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician