1417361528 NPI number — MARIO'S RX PHARMACY LLC

Table of content: (NPI 1417361528)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417361528 NPI number — MARIO'S RX PHARMACY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARIO'S RX PHARMACY LLC
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:
Provider Other Organization Name Type Code:
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:
1417361528
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/05/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6201 S CAGE BLVD
Provider Second Line Business Mailing Address:
STE 3
Provider Business Mailing Address City Name:
PHARR
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78577-5609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-702-5050
Provider Business Mailing Address Fax Number:
956-702-5067

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6201 S CAGE BLVD
Provider Second Line Business Practice Location Address:
STE 3
Provider Business Practice Location Address City Name:
PHARR
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78577-5609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-702-5050
Provider Business Practice Location Address Fax Number:
956-702-5067
Provider Enumeration Date:
06/17/2014

Additional Information

Authorized Official

Authorized Official Last Name:
VARGAS
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
G
Authorized Official Title or Position:
OWNER/DIRECTOR
Authorized Official Telephone Number:
956-534-6990

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  29300 , 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: 29300 . This is a "TEXAS STATE BOARD OF PHARMACY LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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