Provider Demographics
NPI:1770307654
Name:CASTANDA, DAVID MARTIN (RPH)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MARTIN
Last Name:CASTANDA
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 1:9734 KELTON DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-3155
Mailing Address - Country:US
Mailing Address - Phone:210-875-7655
Mailing Address - Fax:
Practice Address - Street 1:10811 TOWN CENTER DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4585
Practice Address - Country:US
Practice Address - Phone:210-572-0911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX300821835C0207X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835C0207XPharmacy Service ProvidersPharmacistCompounded Sterile Preparations