Provider Demographics
NPI:1053412080
Name:CERVANTES, ELIGIO ADRIAN (PHARM D)
Entity type:Individual
Prefix:DR
First Name:ELIGIO
Middle Name:ADRIAN
Last Name:CERVANTES
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 E HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-9160
Mailing Address - Country:US
Mailing Address - Phone:956-496-2093
Mailing Address - Fax:956-496-2098
Practice Address - Street 1:608 E HARRISON AVE
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-9160
Practice Address - Country:US
Practice Address - Phone:956-496-2093
Practice Address - Fax:956-496-2098
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40248332B00000X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX156471802Medicaid
TX145247Medicaid
TX156471802Medicaid