Provider Demographics
NPI:1992395065
Name:REY, ALEXIS ILIANA (RPH)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:ILIANA
Last Name:REY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17119 HIGHWAY 6
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-3739
Mailing Address - Country:US
Mailing Address - Phone:281-489-5621
Mailing Address - Fax:
Practice Address - Street 1:1609 N TEXAS AVE
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77803-1828
Practice Address - Country:US
Practice Address - Phone:979-822-1850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-22
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX304899183700000X
TX74483183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No183700000XPharmacy Service ProvidersPharmacy Technician