Provider Demographics
NPI:1558953240
Name:CANTU, CLARISSA YVETTE (RPH)
Entity Type:Individual
Prefix:
First Name:CLARISSA
Middle Name:YVETTE
Last Name:CANTU
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:CLARISSA
Other - Middle Name:YVETTE
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:2202 SUGAR SWEET STE E
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78599-3760
Mailing Address - Country:US
Mailing Address - Phone:877-449-6661
Mailing Address - Fax:
Practice Address - Street 1:121 PLUMOSA CT
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78552-6633
Practice Address - Country:US
Practice Address - Phone:956-498-8534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX34010183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTX34010OtherTEXAS STATE BOARD OF PHARMACY