Provider Demographics
NPI:1225180383
Name:JC PHARMACY
Entity Type:Organization
Organization Name:JC PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:ESPARZA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:956-782-1144
Mailing Address - Street 1:900 W SAM HOUSTON ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-5217
Mailing Address - Country:US
Mailing Address - Phone:956-782-1144
Mailing Address - Fax:956-702-7723
Practice Address - Street 1:900 W SAM HOUSTON ST
Practice Address - Street 2:SUITE 3
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-5217
Practice Address - Country:US
Practice Address - Phone:956-782-1144
Practice Address - Fax:956-702-7723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17098333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0143232-01Medicaid
TX4597324OtherNABP