Provider Demographics
NPI:1750436101
Name:PEDRO MANUEL YZAGUIRRE JR
Entity type:Organization
Organization Name:PEDRO MANUEL YZAGUIRRE JR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:YZAGUIRRE
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:956-504-9555
Mailing Address - Street 1:5235 SOUTHMOST RD STE C
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-8056
Mailing Address - Country:US
Mailing Address - Phone:956-504-9555
Mailing Address - Fax:956-504-9910
Practice Address - Street 1:5235 SOUTHMOST RD STE C
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-8052
Practice Address - Country:US
Practice Address - Phone:956-504-9555
Practice Address - Fax:956-504-9910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25007333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4929990002Medicare NSC