Marie Diane Bazaldua
Individual provider Active NPI Pharmacist · Eagle Pass, TX
NPI 1962744532 · NPPES record last updated Mar 21, 2013
Key facts
- NPI
- 1962744532
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 26899 (TX)
- Practice address
- 2135 E Main St
Eagle Pass, TX 78852-4895 - Phone
- (830) 773-0420
- NPI assigned
- Mar 21, 2013
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26899 | TX | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| H-E-B, LP | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 26899 | TX | Yes |
Addresses
Primary practice location
2135 E Main St
Eagle Pass, TX 78852-4895
Mailing address
310 Furr Dr
San Antonio, TX 78201-4415
Phone (210) 290-7430
Other providers in Eagle Pass, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 21, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.