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NPI Code Detail

MEDICARE: MR. ALBERT MIRABAL LUCERO RPH

MEDICARE: MR. ALBERT MIRABAL LUCERO 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
1183500000XPharmacist19049TX

General Provider Information

NPI Number : 1598966624
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ALBERT MIRABAL LUCERO RPH
Provider Business Mailing Address
First Line : 700 S OCHOA ST
Second Line :
City : EL PASO
State : TX
Zip : 79901-2936
Country : US
Telephone Number : 915-545-7080
Fax Number : 915-545-7011
Provider Business Practice Location Address
First Line : 700 S OCHOA ST
Second Line :
City : EL PASO
State : TX
Zip : 79901-2936
Country : US
Telephone Number : 915-545-7080
Fax Number : 915-545-7011
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/29/2007
Last Update Date : 07/08/2007

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