Provider Demographics
NPI:1164026019
Name:NEBREA-BALMORES, RETEZ (RPH)
Entity Type:Individual
Prefix:
First Name:RETEZ
Middle Name:
Last Name:NEBREA-BALMORES
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 1:3289 RICHLAND LAKE CV
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-1822
Mailing Address - Country:US
Mailing Address - Phone:731-437-0969
Mailing Address - Fax:
Practice Address - Street 1:3950 AUSTIN PEAY HWY
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-2516
Practice Address - Country:US
Practice Address - Phone:901-377-2422
Practice Address - Fax:901-377-2065
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-22
Last Update Date:2020-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35879183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist