Provider Demographics
NPI:1922760511
Name:COLOSO, RODOLFO AGUIRRE JR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RODOLFO
Middle Name:AGUIRRE
Last Name:COLOSO
Suffix:JR
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 1:14220 SCHLEISMAN RD
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-4020
Mailing Address - Country:US
Mailing Address - Phone:951-340-0875
Mailing Address - Fax:
Practice Address - Street 1:8844 LIMONITE AVE
Practice Address - Street 2:
Practice Address - City:JURUPA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92509-5021
Practice Address - Country:US
Practice Address - Phone:951-968-7218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-11
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84960183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist