Provider Demographics
NPI:1841334943
Name:OLIVAREZ, JAMES EDWARD (RPH)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:OLIVAREZ
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 1:4630 S CLOSNER BLVD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-7279
Mailing Address - Country:US
Mailing Address - Phone:956-289-1880
Mailing Address - Fax:956-289-1873
Practice Address - Street 1:4630 S CLOSNER BLVD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-7279
Practice Address - Country:US
Practice Address - Phone:956-289-1880
Practice Address - Fax:956-289-1873
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28145183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145695Medicaid