Provider Demographics
NPI:1629700588
Name:GUTIERREZ, ROBERT A (PHARMD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7022 N MESA ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-3699
Mailing Address - Country:US
Mailing Address - Phone:915-584-9481
Mailing Address - Fax:
Practice Address - Street 1:7022 N MESA ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-3699
Practice Address - Country:US
Practice Address - Phone:915-584-9481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70394183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist