Provider Demographics
NPI:1942538962
Name:IBARRA, JUAN ANTONIO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:ANTONIO
Last Name:IBARRA
Suffix:
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 1:7586 MOUNTAIN CREEK PKWY
Mailing Address - Street 2:WALGREENS
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75249-1356
Mailing Address - Country:US
Mailing Address - Phone:972-572-2423
Mailing Address - Fax:972-572-2428
Practice Address - Street 1:7586 MOUNTAIN CREEK PKWY
Practice Address - Street 2:WALGREENS
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75249-1356
Practice Address - Country:US
Practice Address - Phone:972-572-2423
Practice Address - Fax:972-572-2428
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-02
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47230183500000X, 1835N0905X
NM7148183500000X, 1835N0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835N0905XPharmacy Service ProvidersPharmacistNuclear