Provider Demographics
NPI:1558656439
Name:MOJICA, HIRAM (BS)
Entity type:Individual
Prefix:
First Name:HIRAM
Middle Name:
Last Name:MOJICA
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8234 AGORA PKWY
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:TX
Mailing Address - Zip Code:78154-1304
Mailing Address - Country:US
Mailing Address - Phone:210-945-9759
Mailing Address - Fax:210-945-9759
Practice Address - Street 1:8234 AGORA PKWY
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:TX
Practice Address - Zip Code:78154-1304
Practice Address - Country:US
Practice Address - Phone:210-945-9759
Practice Address - Fax:210-945-9759
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-18
Last Update Date:2011-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29179183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist