Provider Demographics
NPI:1316612997
Name:CAMACHO, JESUS ROBERTO (PHARM D)
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:ROBERTO
Last Name:CAMACHO
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 1:2950 GEORGE DIETER DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-2913
Mailing Address - Country:US
Mailing Address - Phone:915-856-7040
Mailing Address - Fax:
Practice Address - Street 1:2950 GEORGE DIETER DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-2913
Practice Address - Country:US
Practice Address - Phone:915-856-7040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-15
Last Update Date:2021-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69039183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist