Provider Demographics
NPI:1427224542
Name:MORON VELA INC.
Entity Type:Organization
Organization Name:MORON VELA INC.
Other - Org Name:TLC PHARMACY & MEDICAL EQUIPMENT #1
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FEDERICO
Authorized Official - Middle Name:E
Authorized Official - Last Name:MORON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:956-581-5499
Mailing Address - Street 1:2120 E GRIFFIN PKWY
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3225
Mailing Address - Country:US
Mailing Address - Phone:956-581-5499
Mailing Address - Fax:956-424-6652
Practice Address - Street 1:2120 E GRIFFIN PKWY
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3225
Practice Address - Country:US
Practice Address - Phone:956-581-5499
Practice Address - Fax:956-583-2714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24439333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy