Provider Demographics
NPI:1275159493
Name:GUTIERREZ, HECTOR (PHARMD)
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5872 OLD JACKSONVILLE HWY APT 526
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-0612
Mailing Address - Country:US
Mailing Address - Phone:915-208-9381
Mailing Address - Fax:
Practice Address - Street 1:1105 E GENTRY PKWY
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-4715
Practice Address - Country:US
Practice Address - Phone:903-535-9467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65118183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist