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General NPI Number Information
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NPI Number | 1154519445
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Entity Type | Organization
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Legal Business Name | CENTRO SAN VICENTE PHARMACY
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Dates
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Enumeration Date | 10/11/2007
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Last Update Date | 10/11/2007
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Provider Practice Location Address
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Address Line | 8061 ALAMEDA AVE
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City | EL PASO
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State | TX
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Zip | 79915-4705
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Country | US
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Telephone | 915-859-7545
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Fax | 915-225-2219
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Provider Business Mailing Address
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Address Line | 8061 ALAMEDA AVE
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City | EL PASO
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State | TX
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Zip | 79915-4705
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Country | US
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Telephone | 915-859-7545
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Fax | 915-225-2219
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Authorized Official
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Title or Position | CEO
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Name | MR. DON M. TUFTS
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Credential |
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Telephone | 915-859-7545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | 12995
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License Number State | TX
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