Provider Demographics
NPI:1902951023
Name:PEDRO MANUEL YZAGUIRRE
Entity type:Organization
Organization Name:PEDRO MANUEL YZAGUIRRE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:YZAGUIRRE
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:956-541-2400
Mailing Address - Street 1:4682 LAKEWAY DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-9264
Mailing Address - Country:US
Mailing Address - Phone:956-541-2400
Mailing Address - Fax:956-541-2411
Practice Address - Street 1:4682 LAKEWAY DR
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-9264
Practice Address - Country:US
Practice Address - Phone:956-541-2400
Practice Address - Fax:956-541-2411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22719333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy