Provider Demographics
NPI:1144241118
Name:PUERTO RICO PHARMACY INC
Entity Type:Organization
Organization Name:PUERTO RICO PHARMACY INC
Other - Org Name:LIFECHEK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:GINGRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-232-3940
Mailing Address - Street 1:1116 E 8TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-7288
Mailing Address - Country:US
Mailing Address - Phone:956-968-7733
Mailing Address - Fax:956-968-9802
Practice Address - Street 1:1116 E 8TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-7288
Practice Address - Country:US
Practice Address - Phone:956-968-7733
Practice Address - Fax:956-968-9802
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFECHEK AUCHAN PARTNERS LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-22
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336L0003X
TX244963336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2098914OtherPK
TX145632Medicaid
5639340001Medicare NSC