1780013680 NPI number — LA FERIA DRUG

Table of content: (NPI 1780013680)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780013680 NPI number — LA FERIA DRUG

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LA FERIA DRUG
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:
THE NEIGHBORHOOD 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:
1780013680
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1242 E BUS HWY 83 STE 7
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MISSION
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78572-9308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-583-2700
Provider Business Mailing Address Fax Number:
956-583-2714

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
54 E PRICE RD STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROWNSVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78521-3508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-550-8908
Provider Business Practice Location Address Fax Number:
956-550-8911
Provider Enumeration Date:
11/01/2013

Additional Information

Authorized Official

Authorized Official Last Name:
VELA
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
ALBERTO
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
956-265-9634

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  28786 , 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: 2142846 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 149250 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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