Provider Demographics
NPI:1194496661
Name:CRUZ, IRMA JANETTE
Entity type:Individual
Prefix:
First Name:IRMA
Middle Name:JANETTE
Last Name:CRUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:IRMA
Other - Middle Name:JANETTE
Other - Last Name:VALDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4316 ADDISON CT
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-4184
Mailing Address - Country:US
Mailing Address - Phone:979-450-2281
Mailing Address - Fax:
Practice Address - Street 1:3312 E 29TH ST
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2730
Practice Address - Country:US
Practice Address - Phone:979-776-9128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69538183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist