Provider Demographics
NPI:1225534423
Name:POPULAR RX LLC
Entity Type:Organization
Organization Name:POPULAR RX LLC
Other - Org Name:LA POPULAR PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANIL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOTTIMUKKALA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:973-885-0060
Mailing Address - Street 1:1118 S HIGHWAY 281 BUSINESS
Mailing Address - Street 2:
Mailing Address - City:FALFURRIAS
Mailing Address - State:TX
Mailing Address - Zip Code:78355
Mailing Address - Country:US
Mailing Address - Phone:361-323-3784
Mailing Address - Fax:361-323-0024
Practice Address - Street 1:1118 S HIGHWAY 281 BUSINESS
Practice Address - Street 2:
Practice Address - City:FALFURRIAS
Practice Address - State:TX
Practice Address - Zip Code:78355
Practice Address - Country:US
Practice Address - Phone:361-323-3784
Practice Address - Fax:361-323-0024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-05
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
TX320583336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2176960OtherPK