Provider Demographics
NPI:1114255148
Name:FAVILA, HORACE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:HORACE
Middle Name:
Last Name:FAVILA
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 1:1435 COUNTY ROAD 2801 E
Mailing Address - Street 2:
Mailing Address - City:MICO
Mailing Address - State:TX
Mailing Address - Zip Code:78056-5549
Mailing Address - Country:US
Mailing Address - Phone:817-800-7428
Mailing Address - Fax:
Practice Address - Street 1:1435 COUNTY ROAD 2801 E
Practice Address - Street 2:
Practice Address - City:MICO
Practice Address - State:TX
Practice Address - Zip Code:78056-5549
Practice Address - Country:US
Practice Address - Phone:817-800-7428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-02
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45416183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist