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General NPI Number Information
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NPI Number | 1629791108
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Entity Type | Individual
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Provider Name | LACI ANN BERNAL
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Gender | Female
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Dates
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Enumeration Date | 09/20/2022
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Last Update Date | 09/20/2022
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Provider Practice Location Address
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Address Line | 700 S SAINT MARYS ST
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City | FALFURRIAS
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State | TX
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Zip | 78355-4365
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Country | US
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Telephone | 361-325-2910
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Fax |
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Provider Business Mailing Address
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Address Line | 159 E COUNTY ROAD 2130
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City | KINGSVILLE
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State | TX
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Zip | 78363-8867
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Country | US
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Telephone | 361-522-1715
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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 | 65367
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License Number State | TX
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