Provider Demographics
NPI:1003373184
Name:PHARMACY STATION LLC
Entity Type:Organization
Organization Name:PHARMACY STATION LLC
Other - Org Name:PHARMACY STATION
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:VELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-583-2700
Mailing Address - Street 1:640 S EXPRESSWAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:RAYMONDVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78580
Mailing Address - Country:US
Mailing Address - Phone:956-690-4090
Mailing Address - Fax:956-690-4210
Practice Address - Street 1:640 S EXPRESSWAY
Practice Address - Street 2:SUITE 1
Practice Address - City:RAYMONDVILLE
Practice Address - State:TX
Practice Address - Zip Code:78580
Practice Address - Country:US
Practice Address - Phone:956-690-4090
Practice Address - Fax:956-690-4210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-26
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000OtherNONE
TX150019Medicaid