Provider Demographics
NPI:1033480918
Name:MEDPRO PHARMACY #2
Entity Type:Organization
Organization Name:MEDPRO PHARMACY #2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/PHARMACIST IN CHARG
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:LUJAN
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:972-312-9148
Mailing Address - Street 1:1120 E PARKER RD
Mailing Address - Street 2:STE 210
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-5329
Mailing Address - Country:US
Mailing Address - Phone:972-312-9148
Mailing Address - Fax:972-312-9145
Practice Address - Street 1:1120 E PARKER RD
Practice Address - Street 2:STE 210
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-5329
Practice Address - Country:US
Practice Address - Phone:972-312-9148
Practice Address - Fax:972-312-9145
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDPRO PHARMACY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX278553336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy