Provider Demographics
NPI:1922609817
Name:GUERRERO, GERARDO SR
Entity Type:Individual
Prefix:
First Name:GERARDO
Middle Name:
Last Name:GUERRERO
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 FLOUR BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78418-5102
Mailing Address - Country:US
Mailing Address - Phone:361-937-2626
Mailing Address - Fax:
Practice Address - Street 1:1250 FLOUR BLUFF DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78418-5102
Practice Address - Country:US
Practice Address - Phone:361-937-2626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29051183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist