Provider Demographics
NPI:1134280019
Name:VAL MED LLC
Entity Type:Organization
Organization Name:VAL MED LLC
Other - Org Name:MED AID BICENTENNIAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:EDUARDO
Authorized Official - Last Name:BENITEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:956-618-3100
Mailing Address - Street 1:400 S BICENTENNIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-5199
Mailing Address - Country:US
Mailing Address - Phone:956-618-3100
Mailing Address - Fax:956-618-0057
Practice Address - Street 1:400 S BICENTENNIAL BLVD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-5199
Practice Address - Country:US
Practice Address - Phone:956-618-3100
Practice Address - Fax:956-618-0057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX193163336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144818Medicaid