Provider Demographics
NPI:1275133092
Name:GARCIA, ELIZABETH ANGELA
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANGELA
Last Name:GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 SOUTH BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:ELSA
Mailing Address - State:TX
Mailing Address - Zip Code:78543
Mailing Address - Country:US
Mailing Address - Phone:956-262-9450
Mailing Address - Fax:
Practice Address - Street 1:411 SOUTH BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ELSA
Practice Address - State:TX
Practice Address - Zip Code:78543
Practice Address - Country:US
Practice Address - Phone:956-262-9450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX48859183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist