Provider Demographics
NPI:1891806386
Name:NIGLIAZZO, LUKE L JR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LUKE
Middle Name:L
Last Name:NIGLIAZZO
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8107 ESTATE DR
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-8130
Mailing Address - Country:US
Mailing Address - Phone:956-795-1121
Mailing Address - Fax:956-796-2517
Practice Address - Street 1:1610 E BUSTAMANTE ST
Practice Address - Street 2:SUITE B
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-5455
Practice Address - Country:US
Practice Address - Phone:956-794-8350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42819183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5570230002Medicare NSC