Provider Demographics
NPI:1588108823
Name:RODRIGUEZ, FERNANDO JAVIER (PHARMD)
Entity type:Individual
Prefix:
First Name:FERNANDO
Middle Name:JAVIER
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 1:290 WOODBINE WAY
Mailing Address - Street 2:APT 215
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33418-6540
Mailing Address - Country:US
Mailing Address - Phone:786-281-0603
Mailing Address - Fax:
Practice Address - Street 1:290 WOODBINE WAY
Practice Address - Street 2:APT 215
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33418
Practice Address - Country:US
Practice Address - Phone:786-281-0603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS55901183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist