Provider Demographics
NPI:1881477453
Name:RODRIGUEZ, DESIRAE (PHRM D)
Entity type:Individual
Prefix:MRS
First Name:DESIRAE
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PHRM D
Other - Prefix:DR
Other - First Name:DESIRAE
Other - Middle Name:
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHRM D
Mailing Address - Street 1:1330 KELLY JOHNSON BLVD APT 312
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-4092
Mailing Address - Country:US
Mailing Address - Phone:505-715-7424
Mailing Address - Fax:
Practice Address - Street 1:5060 N ACADEMY BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-4124
Practice Address - Country:US
Practice Address - Phone:719-593-1343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0024523183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist