Provider Demographics
NPI:1831887629
Name:PADILLA, VIANCA MARIE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:VIANCA
Middle Name:MARIE
Last Name:PADILLA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14476 HORIZON BLVD STE J
Mailing Address - Street 2:
Mailing Address - City:HORIZON CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79928-8579
Mailing Address - Country:US
Mailing Address - Phone:915-852-8884
Mailing Address - Fax:
Practice Address - Street 1:14476 HORIZON BLVD STE J
Practice Address - Street 2:
Practice Address - City:HORIZON CITY
Practice Address - State:TX
Practice Address - Zip Code:79928-8579
Practice Address - Country:US
Practice Address - Phone:915-852-8884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71254183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist