Provider Demographics
NPI:1447241278
Name:MOMS PHARMACIES INC
Entity Type:Organization
Organization Name:MOMS PHARMACIES INC
Other - Org Name:MOMS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUILERA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:956-227-9417
Mailing Address - Street 1:PO BOX 4226
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-4226
Mailing Address - Country:US
Mailing Address - Phone:956-447-9933
Mailing Address - Fax:956-447-9993
Practice Address - Street 1:2990 N TEXAS BLVD STE B
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-9696
Practice Address - Country:US
Practice Address - Phone:956-447-9933
Practice Address - Fax:956-447-9993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
TX20760333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145053Medicaid
4517984OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TX145053Medicaid