Provider Demographics
NPI:1013645258
Name:ANTUNEZ, DANIEL ADRIAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ADRIAN
Last Name:ANTUNEZ
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 1:11607 JAMES GRANT DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-5414
Mailing Address - Country:US
Mailing Address - Phone:915-352-7231
Mailing Address - Fax:
Practice Address - Street 1:10301 ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:SOCORRO
Practice Address - State:TX
Practice Address - Zip Code:79927-1605
Practice Address - Country:US
Practice Address - Phone:915-245-3493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-14
Last Update Date:2022-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70856183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX70856OtherTEXAS STATE BOARD OF PHARMACY