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General NPI Number Information
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NPI Number | 1659969400
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Entity Type | Individual
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Provider Name | TAMMY M RODRIGUEZ
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Gender | Female
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Dates
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Enumeration Date | 01/07/2021
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Last Update Date | 01/07/2021
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Provider Practice Location Address
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Address Line | 328 E LANCASTER DR
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City | STOCKTON
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State | CA
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Zip | 95207-5821
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Country | US
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Telephone | 209-817-1456
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 692521
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City | STOCKTON
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State | CA
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Zip | 95269-2521
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 82949
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License Number State | CA
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