Provider Demographics
NPI:1447849815
Name:STORB, ALYSSA CASSANDRA
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:CASSANDRA
Last Name:STORB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18140 SAN PEDRO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-1421
Mailing Address - Country:US
Mailing Address - Phone:210-490-5593
Mailing Address - Fax:
Practice Address - Street 1:18140 SAN PEDRO AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1421
Practice Address - Country:US
Practice Address - Phone:210-490-5593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician