Provider Demographics
NPI:1285002436
Name:QUEZADA, DAGOBERTO (RPH)
Entity Type:Individual
Prefix:
First Name:DAGOBERTO
Middle Name:
Last Name:QUEZADA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:BETO
Other - Middle Name:
Other - Last Name:QEUZADA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:27 GAZELLE FLD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4905
Mailing Address - Country:US
Mailing Address - Phone:210-723-2158
Mailing Address - Fax:
Practice Address - Street 1:27 GAZELLE FLD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4905
Practice Address - Country:US
Practice Address - Phone:210-723-2158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-04
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27425183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist