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General NPI Number Information
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NPI Number | 1558975920
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Entity Type | Individual
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Provider Name | SAMANTHA JO PERALES PHARMD
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Gender | Female
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Dates
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Enumeration Date | 09/03/2020
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Last Update Date | 09/03/2020
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Provider Practice Location Address
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Address Line | 411 S BROADWAY ST
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City | ELSA
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State | TX
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Zip | 78543
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Country | US
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Telephone | 956-262-9450
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Fax | 956-262-9776
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Provider Business Mailing Address
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Address Line | PO BOX 1082
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City | ALAMO
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State | TX
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Zip | 78516-1082
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Country | US
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Telephone | 956-460-3124
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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 | 61292
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License Number State | TX
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