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General NPI Number Information
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NPI Number | 1881477453
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Entity Type | Individual
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Provider Name | DESIRAE RODRIGUEZ PHRM D
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Gender | Female
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Dates
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Enumeration Date | 08/16/2023
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Last Update Date | 08/16/2023
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Provider Practice Location Address
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Address Line | 5060 N ACADEMY BLVD
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-4124
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Country | US
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Telephone | 719-593-1343
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Fax |
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Provider Business Mailing Address
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Address Line | 1330 KELLY JOHNSON BLVD APT 312
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-4092
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Country | US
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Telephone | 505-715-7424
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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 | PHA.0024523
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License Number State | CO
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