Provider Demographics
NPI:1164192530
Name:PIMENTEL, ISIDRO III (CPHT)
Entity Type:Individual
Prefix:
First Name:ISIDRO
Middle Name:
Last Name:PIMENTEL
Suffix:III
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11100 LEOPARD ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-2612
Mailing Address - Country:US
Mailing Address - Phone:361-241-0378
Mailing Address - Fax:
Practice Address - Street 1:11100 LEOPARD ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410-2612
Practice Address - Country:US
Practice Address - Phone:361-241-0378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX309489183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist