Provider Demographics
NPI:1497056493
Name:PATTERSON, ROD ALAN
Entity Type:Individual
Prefix:
First Name:ROD
Middle Name:ALAN
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1649 BRONZE KNOLL RD
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-2610
Mailing Address - Country:US
Mailing Address - Phone:909-860-1696
Mailing Address - Fax:626-821-2584
Practice Address - Street 1:618 MICHILLINDA AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-6342
Practice Address - Country:US
Practice Address - Phone:626-821-7729
Practice Address - Fax:626-821-2584
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-06
Last Update Date:2010-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36989183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist