Provider Demographics
NPI:1629663976
Name:FORSAC, HEPHZIBAH BEULAH
Entity Type:Individual
Prefix:DR
First Name:HEPHZIBAH
Middle Name:BEULAH
Last Name:FORSAC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 CUARZO ST
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-6678
Mailing Address - Country:US
Mailing Address - Phone:713-518-5532
Mailing Address - Fax:
Practice Address - Street 1:3914 N JACKSON RD
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-7768
Practice Address - Country:US
Practice Address - Phone:956-305-2798
Practice Address - Fax:956-305-2887
Is Sole Proprietor?:No
Enumeration Date:2021-03-08
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60211183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist