Healthcare Provider Details

I. General information

NPI: 1255660098
Provider Name (Legal Business Name): ANDRE GILBERTO MONTES R.PH. , PHARM. D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2009
Last Update Date: 12/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1432 ANTONIO ST
ANTHONY TX
79821-7146
US

IV. Provider business mailing address

1432 ANTONIO ST
ANTHONY TX
79821-7146
US

V. Phone/Fax

Practice location:
  • Phone: 915-886-2413
  • Fax:
Mailing address:
  • Phone: 915-886-2413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number47878
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: