Provider Demographics
NPI:1417546805
Name:RODRIQUEZ, DEANNA L
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:L
Last Name:RODRIQUEZ
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 1:1955 NACOGDOCHES RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-2217
Mailing Address - Country:US
Mailing Address - Phone:210-930-3454
Mailing Address - Fax:210-930-3952
Practice Address - Street 1:1955 NACOGDOCHES RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-2217
Practice Address - Country:US
Practice Address - Phone:210-930-3454
Practice Address - Fax:210-930-3952
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician