Provider Demographics
NPI:1508466657
Name:VILLARREAL, DESI LORENZO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DESI
Middle Name:LORENZO
Last Name:VILLARREAL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2107 ALLOY DR
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78542-3802
Mailing Address - Country:US
Mailing Address - Phone:956-467-7559
Mailing Address - Fax:
Practice Address - Street 1:800 E NOLANA AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-6103
Practice Address - Country:US
Practice Address - Phone:956-800-6082
Practice Address - Fax:956-800-6083
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX57720183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist