Individual
EDMUNDO VIVANCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
14300 HORIZON BLVD, HORIZON CITY, TX 79928-8527
(915) 852-1561
Mailing address
6401 CALLE ROJA, EL PASO, TX 79912-3423
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
75935
TX
Other
Enumeration date
09/16/2025
Last updated
09/16/2025
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