Healthcare Provider Details

I. General information

NPI: 1124574116
Provider Name (Legal Business Name): ISANDRA RODRIGUEZ PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2016
Last Update Date: 08/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 HOLLYWOOD BLVD
HOLLYWOOD FL
33021-6810
US

IV. Provider business mailing address

2501 SW 71ST TER APT 106
DAVIE FL
33317-7037
US

V. Phone/Fax

Practice location:
  • Phone: 954-962-4787
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS55502
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: