Provider Demographics
NPI:1215252184
Name:BARRERA, JAIME XAVIER (PHARM D)
Entity type:Individual
Prefix:DR
First Name:JAIME
Middle Name:XAVIER
Last Name:BARRERA
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3509 E MAIN AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ALTON
Mailing Address - State:TX
Mailing Address - Zip Code:78573-1561
Mailing Address - Country:US
Mailing Address - Phone:956-584-7772
Mailing Address - Fax:956-584-7773
Practice Address - Street 1:3509 E MAIN AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:ALTON
Practice Address - State:TX
Practice Address - Zip Code:78573-1561
Practice Address - Country:US
Practice Address - Phone:956-584-7772
Practice Address - Fax:956-584-7773
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-02
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39533183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX39533OtherPHARMACIST LICENSE