Provider Demographics
NPI:1518270347
Name:FELDMAN, MARK IRA (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:IRA
Last Name:FELDMAN
Suffix:
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 1:11507 WHISPER VALLEY ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-3735
Mailing Address - Country:US
Mailing Address - Phone:210-408-7332
Mailing Address - Fax:
Practice Address - Street 1:1630 BANDERA RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-3803
Practice Address - Country:US
Practice Address - Phone:210-432-7334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25419183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist