Healthcare Provider Details

I. General information

NPI: 1215115571
Provider Name (Legal Business Name): STEPHANIE MICHELLE RODRIGUEZ PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 10/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 US HIGHWAY 491
GALLUP NM
87301-5339
US

IV. Provider business mailing address

224 CRESTWOOD CT E
GALLUP NM
87301-7120
US

V. Phone/Fax

Practice location:
  • Phone: 505-722-9977
  • Fax: 505-722-8481
Mailing address:
  • Phone: 505-235-2810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00007012
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: