Provider Demographics
NPI:1184667446
Name:MORON VELA INC
Entity Type:Organization
Organization Name:MORON VELA INC
Other - Org Name:TLC PHARMACY AND MEDICAL EQUIPMENT #2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:VELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-821-2886
Mailing Address - Street 1:1242 EAST HWY BUS 83, #7
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572
Mailing Address - Country:US
Mailing Address - Phone:956-583-2700
Mailing Address - Fax:956-583-2714
Practice Address - Street 1:1242 E BUSINESS HIGHWAY 83
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-9307
Practice Address - Country:US
Practice Address - Phone:956-583-2700
Practice Address - Fax:956-583-2714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
TX244403336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2098845OtherPK
5598750002Medicare NSC
TX180568102OtherMEDICAID DM2
PH0666OtherMEDICARE PART B
4540147OtherNCPDP PROVIDER IDENTIFICATION NUMBER