Provider Demographics
NPI:1093806408
Name:RGV DOCTORS PHARMACY LLC
Entity Type:Organization
Organization Name:RGV DOCTORS PHARMACY LLC
Other - Org Name:DOCTORS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:LEONEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUERRERO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:956-686-0008
Mailing Address - Street 1:5416 S JACKSON RD STE B
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-8332
Mailing Address - Country:US
Mailing Address - Phone:956-686-0008
Mailing Address - Fax:956-213-8135
Practice Address - Street 1:5416 S JACKSON RD STE B
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-8332
Practice Address - Country:US
Practice Address - Phone:956-686-0008
Practice Address - Fax:956-213-8135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24151333600000X
TX26356333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX016729803Medicaid
TX5515240001Medicare NSC