Provider Demographics
NPI:1861481442
Name:GARZA, CARLOS BL (RPH)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:BL
Last Name:GARZA
Suffix:
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 1:1200 S 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-5516
Mailing Address - Country:US
Mailing Address - Phone:956-383-2481
Mailing Address - Fax:956-383-5314
Practice Address - Street 1:1200 S 10TH AVE
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-5516
Practice Address - Country:US
Practice Address - Phone:956-383-2481
Practice Address - Fax:956-383-5314
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX01165183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140645Medicaid