Provider Demographics
NPI:1871679977
Name:HERRERA, RICARDO XAVIER (R PH)
Entity Type:Individual
Prefix:MR
First Name:RICARDO
Middle Name:XAVIER
Last Name:HERRERA
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 LAKE LOUISE CT
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-1926
Mailing Address - Country:US
Mailing Address - Phone:956-337-7470
Mailing Address - Fax:956-727-0064
Practice Address - Street 1:1801 GUST ST
Practice Address - Street 2:SUITE # 1
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-5414
Practice Address - Country:US
Practice Address - Phone:956-727-0607
Practice Address - Fax:956-727-0064
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36235183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX36235OtherTEXAS STATE BOARD #