Provider Demographics
NPI:1346467446
Name:CELSAN LLC
Entity Type:Organization
Organization Name:CELSAN LLC
Other - Org Name:APPLE PHARMACY #2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-534-6990
Mailing Address - Street 1:810 E VETERANS BLVD STE J
Mailing Address - Street 2:
Mailing Address - City:PALMVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:78572-5019
Mailing Address - Country:US
Mailing Address - Phone:956-352-6485
Mailing Address - Fax:956-352-6484
Practice Address - Street 1:810 E VETERANS BLVD STE J
Practice Address - Street 2:
Practice Address - City:PALMVIEW
Practice Address - State:TX
Practice Address - Zip Code:78572-5019
Practice Address - Country:US
Practice Address - Phone:956-352-6485
Practice Address - Fax:956-352-6484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX241433336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145552Medicaid
2097295OtherPK
TX169081001Medicaid
TX174805501Medicaid
TX145552Medicaid