Provider Demographics
NPI:1609208917
Name:TAVAREZ, ALCEE MANUEL II (PHARMACY TECH)
Entity Type:Individual
Prefix:MR
First Name:ALCEE
Middle Name:MANUEL
Last Name:TAVAREZ
Suffix:II
Gender:M
Credentials:PHARMACY TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3908 NE 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79107-7403
Mailing Address - Country:US
Mailing Address - Phone:432-386-0556
Mailing Address - Fax:
Practice Address - Street 1:3908 NE 32ND AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79107-7403
Practice Address - Country:US
Practice Address - Phone:432-386-0556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX138958183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician