Provider Demographics
NPI:1386034981
Name:BROWNSVILLE PHARMACY 3
Entity Type:Organization
Organization Name:BROWNSVILLE PHARMACY 3
Other - Org Name:AUTREY PHARMACY 3
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SRINIVASA
Authorized Official - Middle Name:
Authorized Official - Last Name:TALLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-392-8254
Mailing Address - Street 1:5901 DIAMONDBACK
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-4251
Mailing Address - Country:US
Mailing Address - Phone:956-230-3200
Mailing Address - Fax:956-230-2977
Practice Address - Street 1:800 E ALTON GLOOR BLVD
Practice Address - Street 2:UNIT B
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-4248
Practice Address - Country:US
Practice Address - Phone:267-210-8357
Practice Address - Fax:956-230-2977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX296813336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy