Provider Demographics
NPI:1245820109
Name:OLGUIN, ISAAC EDWIN (REGISTER PHARMACIST)
Entity type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:EDWIN
Last Name:OLGUIN
Suffix:
Gender:M
Credentials:REGISTER PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18333 ROEHAMPTON DR APT 724
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-5176
Mailing Address - Country:US
Mailing Address - Phone:512-695-9145
Mailing Address - Fax:
Practice Address - Street 1:18333 ROEHAMPTON DR APT 724
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-5176
Practice Address - Country:US
Practice Address - Phone:512-695-9145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-24
Last Update Date:2021-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX44798183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX44798OtherTEXAS STATE BOARD OF PHARMACY
1669601878OtherPRIVATE COMAPANY