Provider Demographics
NPI:1245765445
Name:BROWNSVILLE PHARMACY 4 LLC
Entity Type:Organization
Organization Name:BROWNSVILLE PHARMACY 4 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SRINIVASA
Authorized Official - Middle Name:
Authorized Official - Last Name:TALLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-621-1000
Mailing Address - Street 1:3503 BOCA CHICA BLVD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-4057
Mailing Address - Country:US
Mailing Address - Phone:956-621-1000
Mailing Address - Fax:956-621-0037
Practice Address - Street 1:3503 BOCA CHICA BLVD
Practice Address - Street 2:SUITE #1
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-4057
Practice Address - Country:US
Practice Address - Phone:956-621-1000
Practice Address - Fax:956-621-0037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-25
Last Update Date:2018-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX313763336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy