Healthcare Provider Details

I. General information

NPI: 1093648792
Provider Name (Legal Business Name): LOURDES PERCINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1609 N TEXAS AVE
BRYAN TX
77803-1828
US

IV. Provider business mailing address

1609 N TEXAS AVE
BRYAN TX
77803-1828
US

V. Phone/Fax

Practice location:
  • Phone: 979-778-2074
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: