Provider Demographics
NPI:1912588351
Name:RODRIGUEZ, VIVIAN M (RPH)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:M
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10834 SW 225TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33170-6573
Mailing Address - Country:US
Mailing Address - Phone:305-586-6885
Mailing Address - Fax:
Practice Address - Street 1:716 W 29TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-5606
Practice Address - Country:US
Practice Address - Phone:305-883-7476
Practice Address - Fax:305-883-7479
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-17
Last Update Date:2021-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS62145183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist