Provider Demographics
NPI:1356619191
Name:TOVAR, ALFRED GUTIERREZ (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:ALFRED
Middle Name:GUTIERREZ
Last Name:TOVAR
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14505 NW MILITARY HWY
Mailing Address - Street 2:
Mailing Address - City:SHAVANO PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1629
Mailing Address - Country:US
Mailing Address - Phone:210-408-1019
Mailing Address - Fax:
Practice Address - Street 1:14505 NW MILITARY HWY
Practice Address - Street 2:
Practice Address - City:SHAVANO PARK
Practice Address - State:TX
Practice Address - Zip Code:78231-1629
Practice Address - Country:US
Practice Address - Phone:210-408-1019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210931835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist