MEDICARE: DR. RODOLFO AGUIRRE COLOSO JR. 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	84960	CA

General Provider Information

NPI Number	:	1922760511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RODOLFO AGUIRRE COLOSO JR. PHARMD.

Provider Business Mailing Address
First Line	:	14220 SCHLEISMAN RD
Second Line	:
City	:	EASTVALE
State	:	CA
Zip	:	92880-4020
Country	:	US
Telephone Number	:	951-340-0875
Fax Number	:

Provider Business Practice Location Address
First Line	:	8844 LIMONITE AVE
Second Line	:
City	:	JURUPA VALLEY
State	:	CA
Zip	:	92509-5021
Country	:	US
Telephone Number	:	951-968-7218
Fax Number	:

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

Provider Enumeration Date	:	10/11/2021
Last Update Date	:	11/24/2021

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