Provider Demographics
NPI:1710588603
Name:TORRES, MARY LEE M (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARY LEE
Middle Name:M
Last Name:TORRES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N SIMS AVE
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77803-3263
Mailing Address - Country:US
Mailing Address - Phone:281-798-4193
Mailing Address - Fax:
Practice Address - Street 1:1405 EARL RUDDER FWY S
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-6033
Practice Address - Country:US
Practice Address - Phone:979-696-0128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36556183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist