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General NPI Number Information
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NPI Number | 1871256511
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Entity Type | Individual
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Provider Name | DEANA ALLYSA RODRIGUEZ PHARMD
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Gender | Female
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Dates
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Enumeration Date | 10/19/2021
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Last Update Date | 09/17/2023
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Provider Practice Location Address
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Address Line | 2750 E MISSION BLVD
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-3262
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Country | US
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Telephone | 479-442-2134
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Fax |
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Provider Business Mailing Address
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Address Line | 992 JOSIE KATE LN
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City | BETHEL HEIGHTS
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State | AR
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Zip | 72764-6386
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Country | US
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Telephone | 413-478-3874
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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 | PD15894
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License Number State | AR
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