Provider Demographics
NPI:1861711400
Name:GARCIA, JESSE P JR (RPH)
Entity type:Individual
Prefix:MR
First Name:JESSE
Middle Name:P
Last Name:GARCIA
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:JESSE
Other - Middle Name:P
Other - Last Name:GARCIA
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:5801 WEBER RD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413
Mailing Address - Country:US
Mailing Address - Phone:361-854-8504
Mailing Address - Fax:361-841-8360
Practice Address - Street 1:5801 WEBER RD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-3966
Practice Address - Country:US
Practice Address - Phone:361-854-8504
Practice Address - Fax:361-814-8360
Is Sole Proprietor?:No
Enumeration Date:2010-05-21
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20757183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist