Healthcare Provider Details

I. General information

NPI: 1861481442
Provider Name (Legal Business Name): CARLOS B.L. GARZA R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S 10TH AVE
EDINBURG TX
78539-5516
US

IV. Provider business mailing address

1200 S 10TH AVE
EDINBURG TX
78539-5516
US

V. Phone/Fax

Practice location:
  • Phone: 956-383-2481
  • Fax: 956-383-5314
Mailing address:
  • Phone: 956-383-2481
  • Fax: 956-383-5314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number01165
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: