Provider Demographics
NPI:1750552311
Name:RODRIGUEZ, JOSE EFREN MOLINA (RPH)
Entity type:Individual
Prefix:
First Name:JOSE EFREN
Middle Name:MOLINA
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:EFREN
Other - Middle Name:MOLINA
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:4881 N CALLE LLANURA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-9314
Mailing Address - Country:US
Mailing Address - Phone:520-743-7937
Mailing Address - Fax:520-743-7937
Practice Address - Street 1:4881 N CALLE LLANURA
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-9314
Practice Address - Country:US
Practice Address - Phone:520-743-7937
Practice Address - Fax:520-743-7937
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4846183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist