Provider Demographics
NPI:1417586645
Name:LAREDO DOWNTOWN PHARMACY, INC.
Entity Type:Organization
Organization Name:LAREDO DOWNTOWN PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:IZAGUIRRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-726-4512
Mailing Address - Street 1:1219 MATAMOROS ST
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78040-5069
Mailing Address - Country:US
Mailing Address - Phone:956-726-4512
Mailing Address - Fax:956-726-6506
Practice Address - Street 1:1219 MATAMOROS ST
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78040-5069
Practice Address - Country:US
Practice Address - Phone:956-726-4512
Practice Address - Fax:956-726-6506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy