Provider Demographics
NPI:1376724179
Name:MEDIRX II LTD
Entity Type:Organization
Organization Name:MEDIRX II LTD
Other - Org Name:MEDINAS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARCELINO
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:956-702-9009
Mailing Address - Street 1:1044 ACACIA AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:TX
Mailing Address - Zip Code:78516-2401
Mailing Address - Country:US
Mailing Address - Phone:956-702-9009
Mailing Address - Fax:956-702-0246
Practice Address - Street 1:1044 ACACIA AVE
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:TX
Practice Address - Zip Code:78516-2401
Practice Address - Country:US
Practice Address - Phone:956-702-9009
Practice Address - Fax:956-702-0246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
TX258083336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4546492OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TX145860Medicaid
4546492OtherNCPDP PROVIDER IDENTIFICATION NUMBER