Provider Demographics
NPI:1245344019
Name:SOZA, ROBERT L (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:L
Last Name:SOZA
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 E AVENUE E
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:TX
Mailing Address - Zip Code:79830-4816
Mailing Address - Country:US
Mailing Address - Phone:432-837-3931
Mailing Address - Fax:432-837-5033
Practice Address - Street 1:504 E AVENUE E
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:TX
Practice Address - Zip Code:79830-4816
Practice Address - Country:US
Practice Address - Phone:432-837-3931
Practice Address - Fax:432-837-5033
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16603183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
452201OtherNABP
TX110038Medicaid