MEDICARE: AMANDA MARIE 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	50851	TX

General Provider Information

NPI Number	:	1518225440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA MARIE RODRIGUEZ PHARMD

Provider Business Mailing Address
First Line	:	1407 DORA JEANNE DR
Second Line	:
City	:	MISSION
State	:	TX
Zip	:	78572-4357
Country	:	US
Telephone Number	:	956-432-8779
Fax Number	:

Provider Business Practice Location Address
First Line	:	2301 N SHARY RD
Second Line	:
City	:	MISSION
State	:	TX
Zip	:	78574-3241
Country	:	US
Telephone Number	:	956-585-7743
Fax Number	:

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

Provider Enumeration Date	:	04/28/2012
Last Update Date	:	04/28/2012

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