Provider Demographics
NPI:1982564589
Name:LIRA, VICENTE JR (RPHT)
Entity type:Individual
Prefix:MR
First Name:VICENTE
Middle Name:
Last Name:LIRA
Suffix:JR
Gender:M
Credentials:RPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 W 24TH PL
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78574-2210
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2501 N 23RD ST STE B
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-7893
Practice Address - Country:US
Practice Address - Phone:956-627-6652
Practice Address - Fax:833-998-4469
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-15
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100399183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183700000XPharmacy Service ProvidersPharmacy TechnicianGroup - Single Specialty