Provider Demographics
NPI:1851622179
Name:REYNA, NELDA JUDITH
Entity Type:Individual
Prefix:
First Name:NELDA
Middle Name:JUDITH
Last Name:REYNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 E GARDENIA AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-9412
Mailing Address - Country:US
Mailing Address - Phone:956-631-4830
Mailing Address - Fax:956-664-0178
Practice Address - Street 1:900 S 10TH ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-5000
Practice Address - Country:US
Practice Address - Phone:956-630-2911
Practice Address - Fax:956-686-2713
Is Sole Proprietor?:No
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25028183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist