Provider Demographics
NPI:1669233904
Name:CANTU, ALEX DANIEL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:DANIEL
Last Name:CANTU
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 1:1715 W 21ST ST
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-7340
Mailing Address - Country:US
Mailing Address - Phone:956-205-8393
Mailing Address - Fax:
Practice Address - Street 1:1715 W 21ST ST
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-7340
Practice Address - Country:US
Practice Address - Phone:956-205-8393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70220183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist