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NPI Code Detail

MEDICARE: MR. JORGE LUIS CANALES RPH.

MEDICARE: MR. JORGE LUIS CANALES RPH.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist31843TX

General Provider Information

NPI Number : 1053639526
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JORGE LUIS CANALES RPH.
Provider Business Mailing Address
First Line : 1911 NE BOB BULLOCK LOOP
Second Line :
City : LAREDO
State : TX
Zip : 78045-6596
Country : US
Telephone Number : 956-764-5055
Fax Number : 956-764-5081
Provider Business Practice Location Address
First Line : 1911 NE BOB BULLOCK LOOP
Second Line :
City : LAREDO
State : TX
Zip : 78045-6596
Country : US
Telephone Number : 956-764-5055
Fax Number : 956-764-5081
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2010
Last Update Date : 05/09/2010

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Directions to “ MR. JORGE LUIS CANALES RPH.” Practice Location

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