Provider Demographics
NPI:1114685591
Name:RODRIGUEZ VEGA, NADJA CYANEL (RPH)
Entity Type:Individual
Prefix:
First Name:NADJA
Middle Name:CYANEL
Last Name:RODRIGUEZ VEGA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 COHEN WALKER DR APT 2608
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-0767
Mailing Address - Country:US
Mailing Address - Phone:754-422-6157
Mailing Address - Fax:
Practice Address - Street 1:6015 WATSON BLVD
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:GA
Practice Address - Zip Code:31008-6650
Practice Address - Country:US
Practice Address - Phone:478-953-2615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033447183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist