Provider Demographics
NPI:1043254659
Name:RODRIGUEZ, JOHN AGUEDO (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:AGUEDO
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 S CAGE BLVD
Mailing Address - Street 2:STE D
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-5461
Mailing Address - Country:US
Mailing Address - Phone:956-782-8494
Mailing Address - Fax:
Practice Address - Street 1:710 S CAGE BLVD
Practice Address - Street 2:STE D
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-5461
Practice Address - Country:US
Practice Address - Phone:956-782-8494
Practice Address - Fax:956-588-4314
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37473183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX19645OtherSTATE PHARMACY LICENSE NU
TX011219501Medicaid
TX011219502Medicaid