Provider Demographics
NPI:1790387140
Name:DAVILA, SUSANA SALAZAR (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SUSANA
Middle Name:SALAZAR
Last Name:DAVILA
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 1:1015 HIGHWAY 80
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-8176
Mailing Address - Country:US
Mailing Address - Phone:512-353-3000
Mailing Address - Fax:512-353-8621
Practice Address - Street 1:1015 HIGHWAY 80
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-8176
Practice Address - Country:US
Practice Address - Phone:512-353-3000
Practice Address - Fax:512-353-8621
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33103183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist