Provider Demographics
NPI:1346840808
Name:VILLARREAL, LUIS MANUEL SR (RPH)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:MANUEL
Last Name:VILLARREAL
Suffix:SR
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 1:1200 E JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1605
Mailing Address - Country:US
Mailing Address - Phone:956-686-1840
Mailing Address - Fax:956-994-8851
Practice Address - Street 1:1200 E JACKSON AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1605
Practice Address - Country:US
Practice Address - Phone:956-686-1840
Practice Address - Fax:956-994-8851
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28233183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist