Provider Demographics
NPI:1962114884
Name:BANUELOS, RAUL JR (PHARMD)
Entity type:Individual
Prefix:
First Name:RAUL
Middle Name:
Last Name:BANUELOS
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9441 ALAMEDA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79907-5601
Mailing Address - Country:US
Mailing Address - Phone:915-585-1071
Mailing Address - Fax:
Practice Address - Street 1:9441 ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79907-5601
Practice Address - Country:US
Practice Address - Phone:915-858-1071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71706183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX71706OtherTEXAS STATE BOARD OF PHARMACY