Provider Demographics
NPI:1467793877
Name:LAUREL, EZEQUIEL PETER JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:EZEQUIEL
Middle Name:PETER
Last Name:LAUREL
Suffix:JR
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 1:108 N ROSILLO ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-3706
Mailing Address - Country:US
Mailing Address - Phone:210-737-1040
Mailing Address - Fax:
Practice Address - Street 1:108 N ROSILLO ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-3706
Practice Address - Country:US
Practice Address - Phone:210-227-0211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-11
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24518183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist