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NPI Code Detail

MEDICARE: MRS. DEIDRA DEANN RODRIGUEZ

MEDICARE: MRS. DEIDRA DEANN RODRIGUEZ
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist2001004313MO

General Provider Information

NPI Number : 1588946404
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DEIDRA DEANN RODRIGUEZ
Provider Business Mailing Address
First Line : 530 MID RIVERS MALL DR
Second Line :
City : SAINT PETERS
State : MO
Zip : 63376-2150
Country : US
Telephone Number : 636-970-3222
Fax Number :
Provider Business Practice Location Address
First Line : 530 MID RIVERS MALL DR
Second Line :
City : SAINT PETERS
State : MO
Zip : 63376-2150
Country : US
Telephone Number : 636-970-3222
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2011
Last Update Date : 09/16/2011

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Directions to “ MRS. DEIDRA DEANN RODRIGUEZ ” Practice Location

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