Provider Demographics
NPI:1639849086
Name:URIBE LIRA, ROSA I (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:I
Last Name:URIBE LIRA
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5407 ANDREWS HWY
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79706-3615
Mailing Address - Country:US
Mailing Address - Phone:432-699-2331
Mailing Address - Fax:866-605-9415
Practice Address - Street 1:5407 ANDREWS HWY
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79706-3615
Practice Address - Country:US
Practice Address - Phone:432-699-2331
Practice Address - Fax:866-605-9415
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX324676183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician