Provider Demographics
NPI:1245546498
Name:SOTO, JUAN GABRIEL (PHARMD)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:GABRIEL
Last Name:SOTO
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 1:1212 S CLOSNER BLVD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-5664
Mailing Address - Country:US
Mailing Address - Phone:956-380-6219
Mailing Address - Fax:956-380-3190
Practice Address - Street 1:1212 S CLOSNER BLVD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-5664
Practice Address - Country:US
Practice Address - Phone:956-380-6219
Practice Address - Fax:956-380-3190
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43908183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist