Provider Demographics
NPI:1609457761
Name:SEGURA, VIRGINIA T (CRPHT)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:T
Last Name:SEGURA
Suffix:
Gender:F
Credentials:CRPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14501 RANCH ROAD 12
Mailing Address - Street 2:
Mailing Address - City:WIMBERLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78676-6215
Mailing Address - Country:US
Mailing Address - Phone:512-847-3048
Mailing Address - Fax:
Practice Address - Street 1:14501 RANCH ROAD 12
Practice Address - Street 2:
Practice Address - City:WIMBERLEY
Practice Address - State:TX
Practice Address - Zip Code:78676-6215
Practice Address - Country:US
Practice Address - Phone:512-847-3048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100521183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100521OtherTEXAS STATE BOARD OF PHARMACY