Provider Demographics
NPI:1447850664
Name:JUAREZ, ERNEST EUGENE
Entity type:Individual
Prefix:
First Name:ERNEST
Middle Name:EUGENE
Last Name:JUAREZ
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 1:2410 DODSON AVE
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-8009
Mailing Address - Country:US
Mailing Address - Phone:830-775-6995
Mailing Address - Fax:830-775-6805
Practice Address - Street 1:2410 DODSON AVE
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-8009
Practice Address - Country:US
Practice Address - Phone:830-775-6995
Practice Address - Fax:830-775-6805
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34801183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist