Provider Demographics
NPI:1457757817
Name:CARDENAS, MARIO (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:CARDENAS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 S 45TH ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-8107
Mailing Address - Country:US
Mailing Address - Phone:956-655-8092
Mailing Address - Fax:
Practice Address - Street 1:2213 S 45TH ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-8107
Practice Address - Country:US
Practice Address - Phone:956-655-8092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55026183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist