Provider Demographics
NPI:1487306056
Name:RODRIGUEZ, LUIS RENE (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:RENE
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 SANTA FE TRL APT 1086
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-7107
Mailing Address - Country:US
Mailing Address - Phone:469-644-9438
Mailing Address - Fax:
Practice Address - Street 1:1736 N GREENVILLE AVE
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-1808
Practice Address - Country:US
Practice Address - Phone:888-501-0233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69467183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist