MEDICARE: FUERTES INC

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
1	3336C0003X	Community/Retail Pharmacy	26018	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4548636	OTHER		OTHER ID NUMBER

General Provider Information

NPI Number	:	1447411798
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FUERTES INC

Provider Business Mailing Address
First Line	:	2510 BROAD ST
Second Line	:	STE 100
City	:	HOUSTON
State	:	TX
Zip	:	77087-1445
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2510 BROAD ST
Second Line	:	STE 100
City	:	HOUSTON
State	:	TX
Zip	:	77087-1445
Country	:	US
Telephone Number	:	713-641-1383
Fax Number	:	713-641-1034

Authorized Official
Title or Position	:	OWNER
Name	:	EFREN FUENTES
Credential	:
Telephone Number	:	281-827-3757

Provider Enumeration Date	:	06/19/2008
Last Update Date	:	06/19/2008

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Directions to “FUERTES INC ” Practice Location

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