Provider Demographics
NPI:1548037492
Name:ELIZALDE, JOSE (PHARMD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:ELIZALDE
Suffix:
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 1:7606 COWBOY TRAIL LN
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-1435
Mailing Address - Country:US
Mailing Address - Phone:361-720-0225
Mailing Address - Fax:
Practice Address - Street 1:2101 MORGAN AVE
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405-1543
Practice Address - Country:US
Practice Address - Phone:361-887-0789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-11
Last Update Date:2023-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70805183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist