Basic Information
Provider Information
NPI: 1003139825
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RODRIGUEZ
FirstName: ZULIA
MiddleName: INEZ
NamePrefix: MS.
NameSuffix:  
Credential: RPH
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: BROWN
OtherFirstName: ZULIA
OtherMiddleName: INEZ
OtherNamePrefix: MS.
OtherNameSuffix:  
OtherCredential: RPH
OtherLastNameType: 1
Mailing Information
Address1: 323 E ALBANY ST
Address2:  
City: HERKIMER
State: NY
PostalCode: 133502016
CountryCode: US
TelephoneNumber: 3158660274
FaxNumber:  
Practice Location
Address1: 323 E ALBANY ST
Address2:  
City: HERKIMER
State: NY
PostalCode: 133502016
CountryCode: US
TelephoneNumber: 3158660274
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/08/2010
LastUpdateDate: 03/08/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000X049171NYY Pharmacy Service ProvidersPharmacist 

No ID Information.


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