MEDICARE: KASSANDRA RODRIGUEZ PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	053775	NY
2	183500000X	Pharmacist	PH27221	MA

General Provider Information

NPI Number	:	1184951071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASSANDRA RODRIGUEZ PHARMD

Provider Business Mailing Address
First Line	:	5564-68 BROADWAY
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463
Country	:	US
Telephone Number	:	718-548-5884
Fax Number	:

Provider Business Practice Location Address
First Line	:	5564 BROADWAY
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-5216
Country	:	US
Telephone Number	:	718-548-5884
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/12/2009
Last Update Date	:	07/11/2013

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