Provider Demographics
NPI:1396816518
Name:R & L PHARMACY LLC
Entity Type:Organization
Organization Name:R & L PHARMACY LLC
Other - Org Name:PHARRMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:AJAYI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:956-283-0911
Mailing Address - Street 1:1002 WEST SAM HOUSTON
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577
Mailing Address - Country:US
Mailing Address - Phone:956-283-0911
Mailing Address - Fax:956-283-1884
Practice Address - Street 1:1002 WEST SAM HOUSTON
Practice Address - Street 2:SUITE 1
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577
Practice Address - Country:US
Practice Address - Phone:956-283-0911
Practice Address - Fax:956-283-1884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
TX239483336C0003X
TX3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148417Medicaid
TX145507Medicaid