Provider Demographics
NPI:1356845648
Name:JAMES, MARY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:JAMES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2604 SANTA ERICA ST
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-7161
Mailing Address - Country:US
Mailing Address - Phone:919-521-5246
Mailing Address - Fax:
Practice Address - Street 1:POPULAR PHARMACY
Practice Address - Street 2:5326 E US HIGHWAY 83 STE A 5
Practice Address - City:RIO GRANDE CITY
Practice Address - State:TX
Practice Address - Zip Code:78582
Practice Address - Country:US
Practice Address - Phone:956-317-1112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61762183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX61762OtherTEXAS PHARMACIST LIC