Provider Demographics
NPI:1437296605
Name:DE LA ROSA PHARMACY
Entity Type:Organization
Organization Name:DE LA ROSA PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUSTAITA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-968-0403
Mailing Address - Street 1:524 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MERCEDES
Mailing Address - State:TX
Mailing Address - Zip Code:78570-2602
Mailing Address - Country:US
Mailing Address - Phone:956-968-8995
Mailing Address - Fax:956-969-5728
Practice Address - Street 1:1500 E 6TH ST
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6606
Practice Address - Country:US
Practice Address - Phone:956-968-0403
Practice Address - Fax:956-969-3378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX530338OtherBCBS - TX
TX4581458OtherNABP
TX22810OtherST LICENSE
TX=========OtherTX ID
TX4581458OtherNABP