Provider Demographics
NPI:1013563253
Name:RECINOS, MIGUEL ANTONIO (PHARMD)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:ANTONIO
Last Name:RECINOS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7918 N GLEN DR APT 2028
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-7246
Mailing Address - Country:US
Mailing Address - Phone:786-210-8214
Mailing Address - Fax:
Practice Address - Street 1:4100 W AIRPORT FWY
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-5913
Practice Address - Country:US
Practice Address - Phone:972-313-0701
Practice Address - Fax:972-986-2547
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66083183500000X
FLPS59281183500000X
IL051.302187183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist