Provider Demographics
NPI:1235961434
Name:BARRERA, MARCO L
Entity type:Individual
Prefix:
First Name:MARCO
Middle Name:L
Last Name:BARRERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:EDNA
Mailing Address - State:TX
Mailing Address - Zip Code:77957-2703
Mailing Address - Country:US
Mailing Address - Phone:361-781-0789
Mailing Address - Fax:
Practice Address - Street 1:103 W ELM ST
Practice Address - Street 2:
Practice Address - City:EDNA
Practice Address - State:TX
Practice Address - Zip Code:77957-2703
Practice Address - Country:US
Practice Address - Phone:361-781-0789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician