1760526891 NPI number — RX HERRERA PHARMACY, INC

Table of content: (NPI 1760526891)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760526891 NPI number — RX HERRERA PHARMACY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RX HERRERA PHARMACY, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HERRERA PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760526891
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1801 GUST ST
Provider Second Line Business Mailing Address:
SUITE#1
Provider Business Mailing Address City Name:
LAREDO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78041-5414
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-727-0607
Provider Business Mailing Address Fax Number:
956-727-0064

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1801 GUST ST
Provider Second Line Business Practice Location Address:
SUITE#1
Provider Business Practice Location Address City Name:
LAREDO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78041-5414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-727-0607
Provider Business Practice Location Address Fax Number:
956-727-0064
Provider Enumeration Date:
02/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HERRERA
Authorized Official First Name:
RICARDO
Authorized Official Middle Name:
X
Authorized Official Title or Position:
PRESIDENT,PHARMACIST IN CHARGE
Authorized Official Telephone Number:
956-727-0607

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  21296 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 21296 . This is a "TEXAS STATE LICENSE#" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 4521298 . This is a "NAPDP #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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