Provider Demographics
NPI:1467146027
Name:PENA, JOSE L (RPH)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:L
Last Name:PENA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:JOSE
Other - Middle Name:L
Other - Last Name:PENA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1410 MULBERRY DR
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-5505
Mailing Address - Country:US
Mailing Address - Phone:361-813-6706
Mailing Address - Fax:
Practice Address - Street 1:202 W RICE ST
Practice Address - Street 2:
Practice Address - City:FALFURRIAS
Practice Address - State:TX
Practice Address - Zip Code:78355-3704
Practice Address - Country:US
Practice Address - Phone:361-325-2662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25347183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist