Provider Demographics
NPI:1205492451
Name:GUIJARRO, GABRIEL (RPH)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:GUIJARRO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 W FRANK AVE
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3318
Mailing Address - Country:US
Mailing Address - Phone:936-634-3006
Mailing Address - Fax:
Practice Address - Street 1:903 W FRANK AVE
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3318
Practice Address - Country:US
Practice Address - Phone:936-634-3006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28776183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX28776OtherTEXAS STATE BOARD OF PHARMACY LICENSE