Provider Demographics
NPI:1326031469
Name:JOSE GILBERTO TOVAR
Entity Type:Organization
Organization Name:JOSE GILBERTO TOVAR
Other - Org Name:LINDBERG PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:GILBERTO
Authorized Official - Last Name:TOVAR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:956-687-6204
Mailing Address - Street 1:5203 SOUTH MCCOLL RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539
Mailing Address - Country:US
Mailing Address - Phone:956-687-6204
Mailing Address - Fax:956-687-2244
Practice Address - Street 1:5203 SOUTH MCCOLL RD.
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539
Practice Address - Country:US
Practice Address - Phone:956-687-6204
Practice Address - Fax:956-687-2244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13413332B00000X, 332BC3200X, 3336C0003X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0165359-01OtherMEDICAID PROVIDER ID #
TX143528Medicaid
TX143528Medicaid