Provider Demographics
NPI:1295009801
Name:DAVILA, RODOLFO III (RPH)
Entity Type:Individual
Prefix:MR
First Name:RODOLFO
Middle Name:
Last Name:DAVILA
Suffix:III
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 1:1423 GUADALUPE ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-5527
Mailing Address - Country:US
Mailing Address - Phone:210-226-5293
Mailing Address - Fax:210-242-6268
Practice Address - Street 1:1423 GUADALUPE ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-5527
Practice Address - Country:US
Practice Address - Phone:210-226-5293
Practice Address - Fax:210-242-6268
Is Sole Proprietor?:No
Enumeration Date:2012-02-28
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36757183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist