Healthcare Provider Details

I. General information

NPI: 1497877443
Provider Name (Legal Business Name): FRANK CASTANEDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1763 E GARRISON ST
EAGLE PASS TX
78852-5016
US

IV. Provider business mailing address

PO BOX 805
EAGLE PASS TX
78853-0805
US

V. Phone/Fax

Practice location:
  • Phone: 830-758-1622
  • Fax:
Mailing address:
  • Phone: 830-758-1622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number17227
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number17227
License Number StateTX

VIII. Authorized Official

Name: MR. FRANK CASTANEDA
Title or Position: PHARMACIST
Credential:
Phone: 830-758-1622