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General NPI Number Information
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NPI Number | 1659715670
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Entity Type | Individual
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Provider Name | BRUNO ALEJANDRO CANTU PHARMACIST
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Gender | Male
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Dates
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Enumeration Date | 04/21/2013
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Last Update Date | 04/21/2013
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Provider Practice Location Address
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Address Line | 1115 E MAIN ST
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City | ALICE
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State | TX
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Zip | 78332-5046
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Country | US
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Telephone | 361-664-1344
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 96
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City | BENAVIDES
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State | TX
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Zip | 78341-0096
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Country | US
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Telephone | 361-537-6412
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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 | 52616
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License Number State | TX
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