MEDICARE: LESLIE RODRIGUEZ

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	S013209	AZ

General Provider Information

NPI Number	:	1538885363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE RODRIGUEZ

Provider Business Mailing Address
First Line	:	8194 W DEER VALLEY RD STE 106-430
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-2127
Country	:	US
Telephone Number	:	602-819-4784
Fax Number	:

Provider Business Practice Location Address
First Line	:	6685 W BEARDSLEY RD STE 205
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-7193
Country	:	US
Telephone Number	:	602-819-4784
Fax Number	:

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

Provider Enumeration Date	:	10/13/2022
Last Update Date	:	10/13/2022

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Directions to “ LESLIE RODRIGUEZ ” Practice Location

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