Healthcare Provider Details

I. General information

NPI: 1700477759
Provider Name (Legal Business Name): CARRIE LOUISE LANDINO R PH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 E SAN PATRICIO AVE
MATHIS TX
78368-2347
US

IV. Provider business mailing address

213 E SAN PATRICIO AVE
MATHIS TX
78368-2347
US

V. Phone/Fax

Practice location:
  • Phone: 361-547-2577
  • Fax: 361-547-0778
Mailing address:
  • Phone: 361-547-2577
  • Fax: 361-547-0778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number27833
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: