Provider Demographics
NPI:1497358535
Name:RODRIGUEZ, FABIAN JOSEPH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:FABIAN
Middle Name:JOSEPH
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 ROWLAND DR
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-3471
Mailing Address - Country:US
Mailing Address - Phone:805-720-9074
Mailing Address - Fax:
Practice Address - Street 1:500 S BLOSSER RD
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-4910
Practice Address - Country:US
Practice Address - Phone:805-863-9182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA67511183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist