Provider Demographics
NPI:1235904285
Name:ALVAREZ IBARCENA, VICENTE EUSEBIO
Entity Type:Individual
Prefix:
First Name:VICENTE
Middle Name:EUSEBIO
Last Name:ALVAREZ IBARCENA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 ABBOTT AVE
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78541-4255
Mailing Address - Country:US
Mailing Address - Phone:956-376-8001
Mailing Address - Fax:
Practice Address - Street 1:1602 E HIGHWAY 83
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6623
Practice Address - Country:US
Practice Address - Phone:956-376-8001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56065183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist