Provider Demographics
NPI:1083249304
Name:ALLENDE, AGUSTIN L (PHARMD)
Entity Type:Individual
Prefix:
First Name:AGUSTIN
Middle Name:L
Last Name:ALLENDE
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 1:119 HUIZAR ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78214-2707
Mailing Address - Country:US
Mailing Address - Phone:210-922-9031
Mailing Address - Fax:210-927-5577
Practice Address - Street 1:119 HUIZAR ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78214-2707
Practice Address - Country:US
Practice Address - Phone:210-922-9031
Practice Address - Fax:210-927-5577
Is Sole Proprietor?:No
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60869183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist