Individual
MR. JUAN PABLO RESENDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.PH.
Contact information
Practice address
1740 BOCA CHICA BLVD, SUITE 400, BROWNSVILLE, TX 78520-8132
(956) 550-0632
(956) 541-4007
Mailing address
1740 BOCA CHICA BLVD, SUITE 400, BROWNSVILLE, TX 78520-8132
(956) 550-0632
(956) 541-4007
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
31400
TX
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
16854
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
144372
—
TX
01
—
4596081
NCPDP
TX
01
—
74-2765978
FEDERAL TAX ID (IRS#)
—
Enumeration date
06/13/2008
Last updated
05/06/2010
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