Provider Demographics
NPI:1962008920
Name:PALACIOS, ANGEL MIGUEL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:MIGUEL
Last Name:PALACIOS
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 1:14364 DESERT SHADOW DR
Mailing Address - Street 2:
Mailing Address - City:HORIZON CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79928-6454
Mailing Address - Country:US
Mailing Address - Phone:915-207-8313
Mailing Address - Fax:
Practice Address - Street 1:801 SUNLAND PARK DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-5209
Practice Address - Country:US
Practice Address - Phone:915-255-4744
Practice Address - Fax:915-255-4734
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62038183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist