Provider Demographics
NPI:1902191885
Name:VELA, DAVID JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:VELA
Suffix:JR
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 1:18255 BLANCO RD
Mailing Address - Street 2:T-1354
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4585
Mailing Address - Country:US
Mailing Address - Phone:210-764-7972
Mailing Address - Fax:210-764-7972
Practice Address - Street 1:18255 BLANCO RD
Practice Address - Street 2:T-1354
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4585
Practice Address - Country:US
Practice Address - Phone:210-764-7972
Practice Address - Fax:210-764-7972
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-18
Last Update Date:2011-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28232183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist