Provider Demographics
NPI:1437567310
Name:RODRIGUEZ, CRYSTAL ANGELICA (BS,RPH)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:ANGELICA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:BS,RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 E IDAHO AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-3009
Mailing Address - Country:US
Mailing Address - Phone:541-889-6040
Mailing Address - Fax:541-889-9423
Practice Address - Street 1:1775 E IDAHO AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-3009
Practice Address - Country:US
Practice Address - Phone:541-889-6040
Practice Address - Fax:541-889-9423
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9915183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist