Individual
DIEGO BOOTMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
2427 E EXPRESSWAY 83, MISSION, TX 78572-8354
(956) 928-7281
Mailing address
2427 E EXPRESSWAY 83, MISSION, TX 78572-8354
(956) 928-7281
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
41259
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
41259
TEXAS PHARMACY LICENSE
TX
Enumeration date
06/05/2013
Last updated
06/05/2013
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