Healthcare Provider Details

I. General information

NPI: 1184144818
Provider Name (Legal Business Name): RALPH RODRIGUEZ RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2017
Last Update Date: 06/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4647 MEDICAL DR
SAN ANTONIO TX
78229-4403
US

IV. Provider business mailing address

4502 MEDICAL DR
SAN ANTONIO TX
78229-4402
US

V. Phone/Fax

Practice location:
  • Phone: 210-358-4125
  • Fax: 210-358-2679
Mailing address:
  • Phone: 210-358-4125
  • Fax: 210-358-8679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number33447
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: