Healthcare Provider Details

I. General information

NPI: 1427347236
Provider Name (Legal Business Name): MARCELLO RODRIGUEZ PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2011
Last Update Date: 04/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5574 E KINGS CANYON RD
FRESNO CA
93727-4526
US

IV. Provider business mailing address

2748 SCOTT AVENUE
CLOVIS CA
93611
US

V. Phone/Fax

Practice location:
  • Phone: 559-458-0534
  • Fax:
Mailing address:
  • Phone: 559-322-8569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number60383
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: