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General NPI Number Information
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NPI Number | 1376204768
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Entity Type | Individual
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Provider Name | DAVID JACOB CANTU
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Gender | Male
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Dates
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Enumeration Date | 01/07/2022
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Last Update Date | 12/22/2023
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Provider Practice Location Address
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Address Line | 2950 SOUTHMOST RD
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City | BROWNSVILLE
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State | TX
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Zip | 78521-4787
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Country | US
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Telephone | 956-541-8602
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Fax |
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Provider Business Mailing Address
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Address Line | 29660 STATE HIGHWAY 100
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City | LOS FRESNOS
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State | TX
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Zip | 78566-7938
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Country | US
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Telephone | 956-456-8652
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 73604
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License Number State | TX
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