Provider Demographics
NPI:1972269546
Name:FRAUSTO, DEIRDRA VALERIE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:DEIRDRA
Middle Name:VALERIE
Last Name:FRAUSTO
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5208 98TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-4493
Mailing Address - Country:US
Mailing Address - Phone:806-794-1024
Mailing Address - Fax:
Practice Address - Street 1:5208 98TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-4493
Practice Address - Country:US
Practice Address - Phone:806-794-1024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69692183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist