Provider Demographics
NPI:1558868471
Name:LEAL, THAIS IVONNE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:THAIS
Middle Name:IVONNE
Last Name:LEAL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3206 LOS INDIOS PKWY
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-7693
Mailing Address - Country:US
Mailing Address - Phone:956-240-7687
Mailing Address - Fax:
Practice Address - Street 1:212 LINDBERG AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-2920
Practice Address - Country:US
Practice Address - Phone:956-630-6465
Practice Address - Fax:956-630-0816
Is Sole Proprietor?:No
Enumeration Date:2018-04-08
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
183700000X
TX67031183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No183700000XPharmacy Service ProvidersPharmacy Technician