Provider Demographics
NPI:1710620877
Name:RODRIGUEZ, SERGIO JR (RPH)
Entity Type:Individual
Prefix:
First Name:SERGIO
Middle Name:
Last Name:RODRIGUEZ
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 RUBEN TORRES SR BLVD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-7439
Mailing Address - Country:US
Mailing Address - Phone:956-509-2078
Mailing Address - Fax:956-509-2079
Practice Address - Street 1:2205 RUBEN TORRES SR BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-7439
Practice Address - Country:US
Practice Address - Phone:956-509-2078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-17
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38039183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist