Provider Demographics
NPI:1619576568
Name:RODRIGUEZ, EFTHALIA RETSIOS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:EFTHALIA
Middle Name:RETSIOS
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5020 AUTUMN BLOSSOM LN
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-3600
Mailing Address - Country:US
Mailing Address - Phone:704-258-7854
Mailing Address - Fax:
Practice Address - Street 1:7860 REA RD # 16466
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-6502
Practice Address - Country:US
Practice Address - Phone:704-542-8170
Practice Address - Fax:980-345-1265
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13567183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist