MEDICARE: MR. JUAN PABLO RESENDEZ R.PH.

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	31400	TX
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	3336C0003X	Community/Retail Pharmacy	16854	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4596081	OTHER	TX	NCPDP
2	74-2765978	OTHER		FEDERAL TAX ID (IRS#)
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457511370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JUAN PABLO RESENDEZ R.PH.

Provider Business Mailing Address
First Line	:	1740 BOCA CHICA BLVD
Second Line	:	SUITE 400
City	:	BROWNSVILLE
State	:	TX
Zip	:	78520-8132
Country	:	US
Telephone Number	:	956-550-0632
Fax Number	:	956-541-4007

Provider Business Practice Location Address
First Line	:	1740 BOCA CHICA BLVD
Second Line	:	SUITE 400
City	:	BROWNSVILLE
State	:	TX
Zip	:	78520-8132
Country	:	US
Telephone Number	:	956-550-0632
Fax Number	:	956-541-4007

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

Provider Enumeration Date	:	06/13/2008
Last Update Date	:	05/06/2010

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