Provider Demographics
NPI:1720451727
Name:TORRES, MOISES (RPH)
Entity Type:Individual
Prefix:
First Name:MOISES
Middle Name:
Last Name:TORRES
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 1:100 W EXPWY 83
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-6196
Mailing Address - Country:US
Mailing Address - Phone:956-583-0075
Mailing Address - Fax:956-583-0163
Practice Address - Street 1:100 W EXPWY 83
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6196
Practice Address - Country:US
Practice Address - Phone:956-583-0075
Practice Address - Fax:956-583-0163
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31030183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist