Provider Demographics
NPI:1265769285
Name:JARAMILLO, MARIO BARRIOS (RPH)
Entity type:Individual
Prefix:MR
First Name:MARIO
Middle Name:BARRIOS
Last Name:JARAMILLO
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 1:6106 LONGFLOWER LN
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77345-2519
Mailing Address - Country:US
Mailing Address - Phone:281-796-6434
Mailing Address - Fax:
Practice Address - Street 1:101 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TX
Practice Address - Zip Code:77327-4414
Practice Address - Country:US
Practice Address - Phone:281-592-0491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35197183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist