1215006168 NPI number — C&R PHARMACY

Table of content: (NPI 1215006168)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215006168 NPI number — C&R PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
C&R PHARMACY
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:
APPLE PHARMACY #5
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:
1215006168
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2308 EXPRESSWAY 83 STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PENITAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78576-8399
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-271-1064
Provider Business Mailing Address Fax Number:
956-271-1068

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2308 EXPRESSWAY 83 STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENITAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78576-8399
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-271-1064
Provider Business Practice Location Address Fax Number:
956-271-1068
Provider Enumeration Date:
11/07/2006

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/OWNER
Authorized Official Telephone Number:
956-271-1064

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 150545 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2134727 . This is a "PK" identifier . This identifiers is of the category "OTHER".