Provider Demographics
NPI:1104168046
Name:RODRIGUEZ, KIMBERLY DAWN (PHARM D, CPH)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:DAWN
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PHARM D, CPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4937 NW 106TH AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-2709
Mailing Address - Country:US
Mailing Address - Phone:954-234-3261
Mailing Address - Fax:
Practice Address - Street 1:4937 NW 106TH AVE
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33076-2709
Practice Address - Country:US
Practice Address - Phone:954-234-3261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-18
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPU5910183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist