Provider Demographics
NPI:1255668372
Name:AHUMADA, FERNANDO (RPH)
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:
Last Name:AHUMADA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10600 MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-1221
Mailing Address - Country:US
Mailing Address - Phone:915-591-5112
Mailing Address - Fax:915-599-1518
Practice Address - Street 1:10600 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-1221
Practice Address - Country:US
Practice Address - Phone:915-591-5112
Practice Address - Fax:915-599-1518
Is Sole Proprietor?:No
Enumeration Date:2009-11-10
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27849183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist