Provider Demographics
NPI:1083219687
Name:GUTIERREZ, ALMA YVETTE (RPH)
Entity Type:Individual
Prefix:
First Name:ALMA
Middle Name:YVETTE
Last Name:GUTIERREZ
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 1:39 CHAMPIONS RUN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-7702
Mailing Address - Country:US
Mailing Address - Phone:210-392-6803
Mailing Address - Fax:
Practice Address - Street 1:23530 WILDERNESS OAK
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-2406
Practice Address - Country:US
Practice Address - Phone:210-481-7642
Practice Address - Fax:210-481-7928
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29053183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXNONEOtherNONE