Healthcare Provider Details

I. General information

NPI: 1871672261
Provider Name (Legal Business Name): KIMBERLEE R RODRIGUEZ PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2006
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1864 E WASHINGTON BLVD STE 105
PASADENA CA
91104-1667
US

IV. Provider business mailing address

135 SAN MIGUEL DR
ARCADIA CA
91007-3017
US

V. Phone/Fax

Practice location:
  • Phone: 626-398-1696
  • Fax:
Mailing address:
  • Phone: 818-486-9574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number52388
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: