Provider Demographics
NPI:1437686110
Name:CAMPOSANO, RODA (RPH)
Entity Type:Individual
Prefix:
First Name:RODA
Middle Name:
Last Name:CAMPOSANO
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 1:16722 NICKLAUS DR
Mailing Address - Street 2:UNIT 47
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-1676
Mailing Address - Country:US
Mailing Address - Phone:405-208-2348
Mailing Address - Fax:
Practice Address - Street 1:846 W AVENUE K
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-6022
Practice Address - Country:US
Practice Address - Phone:661-942-5652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68657183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist