Provider Demographics
NPI:1104523760
Name:LUJANO, ELISA (RPH)
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:LUJANO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2825
Mailing Address - Street 2:
Mailing Address - City:ROMA
Mailing Address - State:TX
Mailing Address - Zip Code:78584-2825
Mailing Address - Country:US
Mailing Address - Phone:956-802-6096
Mailing Address - Fax:
Practice Address - Street 1:5326 E US HIGHWAY 83 STE A5
Practice Address - Street 2:
Practice Address - City:RIO GRANDE CITY
Practice Address - State:TX
Practice Address - Zip Code:78582-9409
Practice Address - Country:US
Practice Address - Phone:956-317-1112
Practice Address - Fax:956-317-1113
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29376183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist