Basic Information
| Provider Information | |||||||||
| NPI: | 1871256511 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ | ||||||||
| FirstName: | DEANA | ||||||||
| MiddleName: | ALLYSA | ||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 992 JOSIE KATE LN | ||||||||
| Address2: | |||||||||
| City: | BETHEL HEIGHTS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727646386 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4134783874 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 157 GARY HATFIELD WAY | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727403730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4797381270 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2021 | ||||||||
| LastUpdateDate: | 10/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PD15894 | AR | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.