Provider Demographics
NPI:1144971730
Name:ALMANZA, JORGE ADRIAN
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:ADRIAN
Last Name:ALMANZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5610 SAN BERNARDO AVE
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-3009
Mailing Address - Country:US
Mailing Address - Phone:956-723-1411
Mailing Address - Fax:956-791-3700
Practice Address - Street 1:5610 SAN BERNARDO AVE
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-3009
Practice Address - Country:US
Practice Address - Phone:956-723-1411
Practice Address - Fax:956-791-3700
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69146183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist