Provider Demographics
NPI:1073101069
Name:CANALES, MARLO (RPH)
Entity Type:Individual
Prefix:
First Name:MARLO
Middle Name:
Last Name:CANALES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 WISTERIA ST
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78582-6903
Mailing Address - Country:US
Mailing Address - Phone:956-500-3444
Mailing Address - Fax:956-487-6399
Practice Address - Street 1:2790 PHARMACY RD STE A
Practice Address - Street 2:
Practice Address - City:RIO GRANDE CITY
Practice Address - State:TX
Practice Address - Zip Code:78582-6547
Practice Address - Country:US
Practice Address - Phone:956-487-2711
Practice Address - Fax:956-487-2711
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-05
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39074183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist