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NPI Code Detail

MEDICARE: EPHANTUS GAITHO PHARM.D

MEDICARE: EPHANTUS GAITHO PHARM.D
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
1183500000XPharmacist53337TX

General Provider Information

NPI Number : 1023442159
Entity Type Code : Individual
Provider Name (Legal Business Name) : EPHANTUS GAITHO PHARM.D
Provider Business Mailing Address
First Line : 1530 GEORGE DIETER DR APT 13G
Second Line :
City : EL PASO
State : TX
Zip : 79936-7619
Country : US
Telephone Number : 702-769-0451
Fax Number :
Provider Business Practice Location Address
First Line : 1831 N LEE TREVINO DR
Second Line :
City : EL PASO
State : TX
Zip : 79936-4107
Country : US
Telephone Number : 915-594-1129
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2013
Last Update Date : 08/26/2013

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Directions to “ EPHANTUS GAITHO PHARM.D” Practice Location

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