MEDICARE: DR. SERGIO BURCIAGA PHARM D

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	183500000X	Pharmacist	6506	TX

General Provider Information

NPI Number	:	1447862537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SERGIO BURCIAGA PHARM D

Provider Business Mailing Address
First Line	:	12201 MONTWOOD DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79938-2620
Country	:	US
Telephone Number	:	915-856-0278
Fax Number	:

Provider Business Practice Location Address
First Line	:	12201 MONTWOOD DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79938-2620
Country	:	US
Telephone Number	:	915-856-0278
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2020
Last Update Date	:	08/19/2020

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