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General NPI Number Information
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NPI Number | 1669506366
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Entity Type | Organization
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Legal Business Name | CANTUS PHARMACY #4
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5323 S MCCOLL RD STE 101
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City | EDINBURG
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State | TX
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Zip | 78539-9116
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Country | US
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Telephone | 956-994-0113
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Fax | 956-994-0161
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Provider Business Mailing Address
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Address Line | 5323 S MCCOLL RD STE 101
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City | EDINBURG
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State | TX
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Zip | 78539-9116
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Country | US
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Telephone | 956-994-0113
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Fax | 956-994-0161
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Authorized Official
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Title or Position | PHARMACIST
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Name | NARIO RENE CANTU
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Credential | R.PH.
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Telephone | 956-994-0113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 20902
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License Number State | TX
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