Provider Demographics
NPI:1013341403
Name:VILLANUEVA, JOHN M IV (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:VILLANUEVA
Suffix:IV
Gender:M
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 1:1300 S CAGE BLVD
Mailing Address - Street 2:PHARMACY
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-6293
Mailing Address - Country:US
Mailing Address - Phone:956-781-6626
Mailing Address - Fax:956-781-0561
Practice Address - Street 1:1300 S CAGE BLVD
Practice Address - Street 2:PHARMACY
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-6293
Practice Address - Country:US
Practice Address - Phone:956-781-6626
Practice Address - Fax:956-781-0561
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX53374183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist