Provider Demographics
NPI:1386962967
Name:VILLARREAL, LYDIA JEAN (RPH)
Entity type:Individual
Prefix:MRS
First Name:LYDIA
Middle Name:JEAN
Last Name:VILLARREAL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 LEOPARD ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78408-3204
Mailing Address - Country:US
Mailing Address - Phone:361-883-7196
Mailing Address - Fax:361-884-6387
Practice Address - Street 1:3500 LEOPARD ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78408-3204
Practice Address - Country:US
Practice Address - Phone:361-883-7196
Practice Address - Fax:361-884-6387
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24881183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist