Provider Demographics
NPI:1285250431
Name:AVINA-CAMPOS, RICARDO (PHARMD)
Entity type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:
Last Name:AVINA-CAMPOS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:RICARDO
Other - Middle Name:
Other - Last Name:AVINA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3208 FLUVIA
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-6715
Mailing Address - Country:US
Mailing Address - Phone:682-365-5976
Mailing Address - Fax:
Practice Address - Street 1:1025 W TRINITY MILLS RD
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-1375
Practice Address - Country:US
Practice Address - Phone:800-508-0960
Practice Address - Fax:877-969-9123
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX57063183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist