Provider Demographics
NPI:1033966320
Name:CANCHE, SANJUANITA
Entity type:Individual
Prefix:
First Name:SANJUANITA
Middle Name:
Last Name:CANCHE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 W HIBISCUS AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-9447
Mailing Address - Country:US
Mailing Address - Phone:956-249-0841
Mailing Address - Fax:
Practice Address - Street 1:1501 W KELLY AVE
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-5031
Practice Address - Country:US
Practice Address - Phone:956-354-3901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy