Provider Demographics
NPI:1346475449
Name:MED-AID PHARMACY STONERIDGE, LLC
Entity Type:Organization
Organization Name:MED-AID PHARMACY STONERIDGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:CALVILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-687-5646
Mailing Address - Street 1:5323 S MCCOLL RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-9115
Mailing Address - Country:US
Mailing Address - Phone:956-687-5646
Mailing Address - Fax:
Practice Address - Street 1:5323 S MCCOLL RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-9115
Practice Address - Country:US
Practice Address - Phone:956-687-5646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy