Provider Demographics
NPI:1851997746
Name:RODRIGUEZ, LUIS JR (RPH)
Entity Type:Individual
Prefix:
First Name:LUIS
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 1:91 W PIERREPONT AVE
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-2608
Mailing Address - Country:US
Mailing Address - Phone:201-281-1319
Mailing Address - Fax:973-365-0925
Practice Address - Street 1:175 MAIN ST
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:NJ
Practice Address - Zip Code:07644-1723
Practice Address - Country:US
Practice Address - Phone:973-365-2289
Practice Address - Fax:973-365-0925
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01952700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist