Provider Demographics
NPI:1952494148
Name:FONSECA, RUBEN P (RPH)
Entity Type:Individual
Prefix:
First Name:RUBEN
Middle Name:P
Last Name:FONSECA
Suffix:
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 1:3808 N 1ST LN E
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-9108
Mailing Address - Country:US
Mailing Address - Phone:956-793-8568
Mailing Address - Fax:956-969-2845
Practice Address - Street 1:1010 S. AIRPORT
Practice Address - Street 2:SUTIE A
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6650
Practice Address - Country:US
Practice Address - Phone:956-969-0636
Practice Address - Fax:956-969-2845
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24453183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy