Provider Demographics
NPI:1104872498
Name:ESPERICUETA, OMAR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:OMAR
Middle Name:
Last Name:ESPERICUETA
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 1:2308 HWY 83
Mailing Address - Street 2:STE A
Mailing Address - City:PENITAS
Mailing Address - State:TX
Mailing Address - Zip Code:78576-8398
Mailing Address - Country:US
Mailing Address - Phone:956-580-3500
Mailing Address - Fax:956-580-3535
Practice Address - Street 1:2308 HWY 83
Practice Address - Street 2:STE A
Practice Address - City:PENITAS
Practice Address - State:TX
Practice Address - Zip Code:78576-8398
Practice Address - Country:US
Practice Address - Phone:956-580-3500
Practice Address - Fax:956-580-3535
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX418471835P1200X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No183500000XPharmacy Service ProvidersPharmacist