Provider Demographics
NPI:1083217475
Name:BLANCIA, FRIEDA DJOHANNA MOSCOSO (RPH)
Entity Type:Individual
Prefix:MS
First Name:FRIEDA DJOHANNA
Middle Name:MOSCOSO
Last Name:BLANCIA
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 1:11600 SHADOW CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7261
Mailing Address - Country:US
Mailing Address - Phone:713-436-8250
Mailing Address - Fax:713-436-8256
Practice Address - Street 1:11600 SHADOW CREEK PKWY
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7261
Practice Address - Country:US
Practice Address - Phone:713-436-8250
Practice Address - Fax:713-436-8256
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist