Provider Demographics
NPI:1689998791
Name:RODRIGUEZ, PAUL VINCENT ONGSUECO (PHARMD)
Entity type:Individual
Prefix:DR
First Name:PAUL VINCENT
Middle Name:ONGSUECO
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135-42 COOLIDGE AVE, APT #2
Mailing Address - Street 2:
Mailing Address - City:QUEENS
Mailing Address - State:NY
Mailing Address - Zip Code:11435
Mailing Address - Country:US
Mailing Address - Phone:347-223-9390
Mailing Address - Fax:212-663-8153
Practice Address - Street 1:2833 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025
Practice Address - Country:US
Practice Address - Phone:212-663-3135
Practice Address - Fax:212-663-8153
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20053795183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist