Provider Demographics
NPI:1255660098
Name:MONTES, ANDRE GILBERTO (RPH , PHARM D)
Entity type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:GILBERTO
Last Name:MONTES
Suffix:
Gender:M
Credentials:RPH , PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 ANTONIO ST
Mailing Address - Street 2:
Mailing Address - City:ANTHONY
Mailing Address - State:TX
Mailing Address - Zip Code:79821-7146
Mailing Address - Country:US
Mailing Address - Phone:915-886-2413
Mailing Address - Fax:
Practice Address - Street 1:1432 ANTONIO ST
Practice Address - Street 2:
Practice Address - City:ANTHONY
Practice Address - State:TX
Practice Address - Zip Code:79821-7146
Practice Address - Country:US
Practice Address - Phone:915-886-2413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-07
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47878183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist