Provider Demographics
NPI:1245515493
Name:RODRIGUEZ, SAMUEL (RPH)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:RODRIGUEZ
Suffix:
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 1:995 SPERRY AVE
Mailing Address - Street 2:
Mailing Address - City:PATTERSON
Mailing Address - State:CA
Mailing Address - Zip Code:95363-9262
Mailing Address - Country:US
Mailing Address - Phone:209-894-3700
Mailing Address - Fax:209-894-3704
Practice Address - Street 1:995 SPERRY AVE
Practice Address - Street 2:
Practice Address - City:PATTERSON
Practice Address - State:CA
Practice Address - Zip Code:95363-9262
Practice Address - Country:US
Practice Address - Phone:209-894-3700
Practice Address - Fax:209-894-3704
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46295183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist