Provider Demographics
NPI:1174890560
Name:BAEZA, VERONICA ELISA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:VERONICA
Middle Name:ELISA
Last Name:BAEZA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12321 KIT CARSON DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-6874
Mailing Address - Country:US
Mailing Address - Phone:915-861-3022
Mailing Address - Fax:
Practice Address - Street 1:14300 HORIZON BLVD
Practice Address - Street 2:
Practice Address - City:HORIZON CITY
Practice Address - State:TX
Practice Address - Zip Code:79928-8527
Practice Address - Country:US
Practice Address - Phone:915-852-1561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49984183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist