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General NPI Number Information
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NPI Number | 1376219493
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Entity Type | Individual
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Provider Name | HECTOR BURGARA JR. PHARMD
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Gender | Male
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Dates
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Enumeration Date | 08/18/2021
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Last Update Date | 08/18/2021
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Provider Practice Location Address
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Address Line | 3501 N STOCKTON HILL RD
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City | KINGMAN
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State | AZ
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Zip | 86409-3227
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Country | US
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Telephone | 928-757-1999
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Fax | 928-757-4441
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Provider Business Mailing Address
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Address Line | 5618 MIDNIGHT BREEZE ST
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89081-3015
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Country | US
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Telephone |
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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 | S025322
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License Number State | AZ
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