Provider Demographics
NPI:1588005664
Name:HEREDIA, GRECIA (PHARMD, AAHIVP)
Entity type:Individual
Prefix:DR
First Name:GRECIA
Middle Name:
Last Name:HEREDIA
Suffix:
Gender:F
Credentials:PHARMD, AAHIVP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 E SCHUSTER AVE STE 1A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4646
Mailing Address - Country:US
Mailing Address - Phone:915-229-6448
Mailing Address - Fax:
Practice Address - Street 1:1201 E SCHUSTER AVE STE 1A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4646
Practice Address - Country:US
Practice Address - Phone:915-229-6448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX53273183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist