Provider Demographics
NPI:1871167569
Name:CALVILLO, KRISTIAN DAVID
Entity type:Individual
Prefix:
First Name:KRISTIAN
Middle Name:DAVID
Last Name:CALVILLO
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 1:3640 CADENA DR
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-2204
Mailing Address - Country:US
Mailing Address - Phone:281-740-9388
Mailing Address - Fax:
Practice Address - Street 1:12680 W LAKE HOUSTON PKWY # 8
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77044-6087
Practice Address - Country:US
Practice Address - Phone:281-436-1969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX194069183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician