Provider Demographics
NPI:1467845511
Name:CAVAZOS, ELIAS JR
Entity Type:Individual
Prefix:
First Name:ELIAS
Middle Name:
Last Name:CAVAZOS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5425 S PADRE ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-5301
Mailing Address - Country:US
Mailing Address - Phone:361-980-8979
Mailing Address - Fax:361-445-3363
Practice Address - Street 1:5425 S PADRE ISLAND DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-5301
Practice Address - Country:US
Practice Address - Phone:361-980-8979
Practice Address - Fax:361-445-3363
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-13
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27866183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist