Healthcare Provider Details

I. General information

NPI: 1376219493
Provider Name (Legal Business Name): HECTOR BURGARA JR. PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2021
Last Update Date: 05/17/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4747 HWY 95
FORT MOHAVE AZ
86426-9377
US

IV. Provider business mailing address

5618 MIDNIGHT BREEZE ST
NORTH LAS VEGAS NV
89081-3015
US

V. Phone/Fax

Practice location:
  • Phone: 928-251-7045
  • Fax: 833-874-1887
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS025322
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: