Provider Demographics
NPI:1689840134
Name:RODRIGUEZ, MARIO E (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARIO
Middle Name:E
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:PO BOX 2070
Mailing Address - Street 2:
Mailing Address - City:CORTARO
Mailing Address - State:AZ
Mailing Address - Zip Code:85652-2070
Mailing Address - Country:US
Mailing Address - Phone:520-991-1863
Mailing Address - Fax:
Practice Address - Street 1:7952 N HIGGINS FEATHER DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85743-7423
Practice Address - Country:US
Practice Address - Phone:520-991-1863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10862183500000X
NV13424183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist