Provider Demographics
NPI:1891390787
Name:RODRIGUEZ, FERNANDO LUIS (PHARMD)
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:LUIS
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 1:1155 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60404-0701
Mailing Address - Country:US
Mailing Address - Phone:815-741-5023
Mailing Address - Fax:815-741-5029
Practice Address - Street 1:1155 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:IL
Practice Address - Zip Code:60404-0701
Practice Address - Country:US
Practice Address - Phone:815-741-5023
Practice Address - Fax:815-741-5029
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051300436183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist