Provider Demographics
NPI:1356064174
Name:BULSECO, ALFONSO (RPH)
Entity type:Individual
Prefix:
First Name:ALFONSO
Middle Name:
Last Name:BULSECO
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 1:1801 W BAY AREA BLVD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-3403
Mailing Address - Country:US
Mailing Address - Phone:281-819-4117
Mailing Address - Fax:281-724-2080
Practice Address - Street 1:1801 W BAY AREA BLVD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-3403
Practice Address - Country:US
Practice Address - Phone:281-819-4117
Practice Address - Fax:281-724-2080
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65065183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist