Provider Demographics
NPI:1386975456
Name:PENA, FRANCISCO I JR
Entity type:Individual
Prefix:MR
First Name:FRANCISCO
Middle Name:I
Last Name:PENA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 GUADALUPE ST
Mailing Address - Street 2:PHARMACY
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78040-5343
Mailing Address - Country:US
Mailing Address - Phone:956-724-1126
Mailing Address - Fax:956-721-0642
Practice Address - Street 1:1301 GUADALUPE ST
Practice Address - Street 2:PHARMACY
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78040-5343
Practice Address - Country:US
Practice Address - Phone:956-724-1126
Practice Address - Fax:956-721-0642
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27423183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist