=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265192470
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAIME PADILLA RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2021
-----------------------------------------------------
Last Update Date | 12/29/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3600 N 23RD ST
-----------------------------------------------------
City | MCALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78501-6144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-627-6127
-----------------------------------------------------
Fax | 817-382-5174
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 64 S AZTEC COVE DR
-----------------------------------------------------
City | INDIAN LAKE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78566-4113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-204-9744
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 30269
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------