Provider Demographics
NPI:1023623683
Name:CANTU, CAROLINA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CAROLINA
Middle Name:
Last Name:CANTU
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 STANFORD CT
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78541-9841
Mailing Address - Country:US
Mailing Address - Phone:956-573-4911
Mailing Address - Fax:
Practice Address - Street 1:2700 W FREDDY GONZALEZ DR
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-7312
Practice Address - Country:US
Practice Address - Phone:956-383-4083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX237052183700000X
TX36691390200000X
TX69109183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No183700000XPharmacy Service ProvidersPharmacy Technician
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX69109OtherTEXAS STATE BOARD OF PHARMACY