Healthcare Provider Details

I. General information

NPI: 1144800277
Provider Name (Legal Business Name): MARILOU SEVILLA OLOHOY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 04/13/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14087 OCONNOR RD
SAN ANTONIO TX
78247-1979
US

IV. Provider business mailing address

16918 VISTA BLF DR
SAN ANTONIO TX
78247-4659
US

V. Phone/Fax

Practice location:
  • Phone: 210-637-0033
  • Fax:
Mailing address:
  • Phone: 210-442-8598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number157189
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: