Provider Demographics
NPI:1821709817
Name:CANALES, ERASMO JR
Entity Type:Individual
Prefix:
First Name:ERASMO
Middle Name:
Last Name:CANALES
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4305 N CONWAY AVE
Mailing Address - Street 2:
Mailing Address - City:PALMHURST
Mailing Address - State:TX
Mailing Address - Zip Code:78573-1372
Mailing Address - Country:US
Mailing Address - Phone:956-519-7523
Mailing Address - Fax:956-519-7495
Practice Address - Street 1:4305 N CONWAY AVE
Practice Address - Street 2:
Practice Address - City:PALMHURST
Practice Address - State:TX
Practice Address - Zip Code:78573-1372
Practice Address - Country:US
Practice Address - Phone:956-519-7523
Practice Address - Fax:956-519-7495
Is Sole Proprietor?:No
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71786183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist