Provider Demographics
NPI:1730936337
Name:RODRIGUEZ, RANDY
Entity type:Individual
Prefix:MR
First Name:RANDY
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001A JEROME AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-1803
Mailing Address - Country:US
Mailing Address - Phone:929-647-2900
Mailing Address - Fax:347-808-2470
Practice Address - Street 1:2001A JEROME AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-1803
Practice Address - Country:US
Practice Address - Phone:929-647-2900
Practice Address - Fax:347-808-2470
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy