Provider Demographics
NPI:1558964510
Name:VASSAR, NOLAN (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:NOLAN
Middle Name:
Last Name:VASSAR
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 PALACIOS DR
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-7807
Mailing Address - Country:US
Mailing Address - Phone:956-867-2844
Mailing Address - Fax:
Practice Address - Street 1:103 W MONTE CRISTO RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78541-6840
Practice Address - Country:US
Practice Address - Phone:956-383-4945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24880183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist