Provider Demographics
NPI:1346429461
Name:GUERRA PHARMACY INC
Entity Type:Organization
Organization Name:GUERRA PHARMACY INC
Other - Org Name:ABC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AROLSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-584-9828
Mailing Address - Street 1:1618 N CONWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-4004
Mailing Address - Country:US
Mailing Address - Phone:956-584-9828
Mailing Address - Fax:956-584-9458
Practice Address - Street 1:1618 N CONWAY AVE
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-4004
Practice Address - Country:US
Practice Address - Phone:956-584-9828
Practice Address - Fax:956-584-9458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX218483336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149855201Medicaid
4505256OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TX149855203Medicaid
TX149855201Medicaid