Provider Demographics
NPI:1144425810
Name:BROWNSVILLE FAMILY PHARMACY, INC
Entity Type:Organization
Organization Name:BROWNSVILLE FAMILY PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BENITEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:956-541-1112
Mailing Address - Street 1:44 W JEFFERSON ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-6258
Mailing Address - Country:US
Mailing Address - Phone:956-541-1112
Mailing Address - Fax:956-541-1112
Practice Address - Street 1:44 W JEFFERSON ST
Practice Address - Street 2:SUITE A
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-6258
Practice Address - Country:US
Practice Address - Phone:956-541-1112
Practice Address - Fax:956-541-1112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25433333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4544070Medicaid