Provider Demographics
NPI:1831238708
Name:VILLANUEVA, LUIS P (PHARMACIST)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:P
Last Name:VILLANUEVA
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 W COMMERCE ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-3839
Mailing Address - Country:US
Mailing Address - Phone:210-922-0103
Mailing Address - Fax:210-922-0612
Practice Address - Street 1:6315 S ZARZAMORA ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78211-3218
Practice Address - Country:US
Practice Address - Phone:210-924-9254
Practice Address - Fax:210-927-6436
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18925183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist