Provider Demographics
NPI:1033516588
Name:S. MIAN, LLC
Entity Type:Organization
Organization Name:S. MIAN, LLC
Other - Org Name:DANIEL'S PHARMACY #1
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:VELA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:956-583-2700
Mailing Address - Street 1:4115 PECAN BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-3695
Mailing Address - Country:US
Mailing Address - Phone:956-627-4128
Mailing Address - Fax:956-627-4416
Practice Address - Street 1:4115 PECAN BLVD STE C
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-3695
Practice Address - Country:US
Practice Address - Phone:956-627-4128
Practice Address - Fax:956-627-4416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-28
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX297133336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148424Medicaid