Provider Demographics
NPI:1508954041
Name:RODRIGUEZ, JOSE R (BS RPH)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:R
Last Name:RODRIGUEZ
Suffix:
Gender:M
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 1:4292 N ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:COCOA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32931-3512
Mailing Address - Country:US
Mailing Address - Phone:321-784-0503
Mailing Address - Fax:321-799-8632
Practice Address - Street 1:4292 N ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-3512
Practice Address - Country:US
Practice Address - Phone:321-784-0503
Practice Address - Fax:321-799-8632
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS46143183500000X
PR43811835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Not Answered1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1508954041OtherNPPES