Healthcare Provider Details

I. General information

NPI: 1720356777
Provider Name (Legal Business Name): RALPH CANO JR. CPHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2011
Last Update Date: 12/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 N SAGINAW BLVD
SAGINAW TX
76179-1234
US

IV. Provider business mailing address

4210 BONITA DR
FORT WORTH TX
76114-3809
US

V. Phone/Fax

Practice location:
  • Phone: 817-306-7147
  • Fax:
Mailing address:
  • Phone: 817-437-3480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number105965
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: