Provider Demographics
NPI:1962404624
Name:CAVAZOS, JOHN ZACARIAS (RPH)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ZACARIAS
Last Name:CAVAZOS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1922 E GRIFFIN PKWY
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3042
Mailing Address - Country:US
Mailing Address - Phone:956-583-4372
Mailing Address - Fax:956-583-4376
Practice Address - Street 1:1922 E GRIFFIN PKWY
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3042
Practice Address - Country:US
Practice Address - Phone:956-583-4372
Practice Address - Fax:956-583-4376
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18324183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPH0278Medicare ID - Type UnspecifiedROSTER BILLING(FLU-PNEU)