Provider Demographics
NPI:1922463504
Name:FONSECA, ENRIQUEZ (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ENRIQUEZ
Middle Name:
Last Name:FONSECA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:HENRY
Other - Middle Name:
Other - Last Name:FONSECA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1209 S. 10TH STREET SUITE A
Mailing Address - Street 2:#129
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501
Mailing Address - Country:US
Mailing Address - Phone:956-857-4823
Mailing Address - Fax:
Practice Address - Street 1:1209 S 10TH ST STE A
Practice Address - Street 2:#129
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-5060
Practice Address - Country:US
Practice Address - Phone:956-857-4823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-23
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX44104183500000X, 1835P0018X, 1835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
No183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist