Provider Demographics
NPI:1043938426
Name:CARRIZALES, MARCOS FABIAN
Entity Type:Individual
Prefix:MR
First Name:MARCOS
Middle Name:FABIAN
Last Name:CARRIZALES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 BUSINESS CENTER DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-2191
Mailing Address - Country:US
Mailing Address - Phone:713-578-6155
Mailing Address - Fax:866-412-0213
Practice Address - Street 1:2805 BUSINESS CENTER DR
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-2191
Practice Address - Country:US
Practice Address - Phone:713-578-6155
Practice Address - Fax:866-412-0213
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX322294183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician