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NPI Code Detail

MEDICARE: MRS. ELSA G. FUENTES R.PH.

MEDICARE: MRS. ELSA G. FUENTES 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
1183500000XPharmacist35893TX

General Provider Information

NPI Number : 1922327501
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ELSA G. FUENTES R.PH.
Provider Business Mailing Address
First Line : 8113 ESTATE DR
Second Line :
City : LAREDO
State : TX
Zip : 78045-8130
Country : US
Telephone Number : 956-727-2292
Fax Number :
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 : 956-764-5050
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2010
Last Update Date : 05/22/2010

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