Provider Demographics
NPI:1659715670
Name:CANTU, BRUNO ALEJANDRO (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:BRUNO
Middle Name:ALEJANDRO
Last Name:CANTU
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 96
Mailing Address - Street 2:
Mailing Address - City:BENAVIDES
Mailing Address - State:TX
Mailing Address - Zip Code:78341-0096
Mailing Address - Country:US
Mailing Address - Phone:361-537-6412
Mailing Address - Fax:
Practice Address - Street 1:1115 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-5046
Practice Address - Country:US
Practice Address - Phone:361-664-1344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-21
Last Update Date:2013-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX52616183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist