Provider Demographics
NPI:1952901050
Name:PENA, JUAN AMANDO JR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:AMANDO
Last Name:PENA
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 W NOLANA AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-4596
Mailing Address - Country:US
Mailing Address - Phone:956-631-8305
Mailing Address - Fax:956-631-6170
Practice Address - Street 1:2800 W NOLANA AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-4596
Practice Address - Country:US
Practice Address - Phone:956-631-8305
Practice Address - Fax:956-631-6170
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50055183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist