Provider Demographics
NPI:1801110325
Name:CHAVES, GALO EFRAIN (RPH)
Entity type:Individual
Prefix:MR
First Name:GALO
Middle Name:EFRAIN
Last Name:CHAVES
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 1:7218 SAINT JAMES CT
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-5129
Mailing Address - Country:US
Mailing Address - Phone:361-815-3445
Mailing Address - Fax:
Practice Address - Street 1:1400 WILDCAT DR
Practice Address - Street 2:PHARMACY
Practice Address - City:PORTLAND
Practice Address - State:TX
Practice Address - Zip Code:78374-2813
Practice Address - Country:US
Practice Address - Phone:361-643-8576
Practice Address - Fax:361-643-0705
Is Sole Proprietor?:No
Enumeration Date:2010-03-26
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18773183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist