Provider Demographics
NPI:1811583388
Name:BARRAZA, GILBERT IGNACIO III (RPH)
Entity Type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:IGNACIO
Last Name:BARRAZA
Suffix:III
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12515 WESLEY CRK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-4554
Mailing Address - Country:US
Mailing Address - Phone:915-345-7169
Mailing Address - Fax:
Practice Address - Street 1:9800 FREDERICKSBURG RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78288-0001
Practice Address - Country:US
Practice Address - Phone:210-498-3784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59061183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty