Provider Demographics
NPI:1508073115
Name:DE LA ROSA PHARMACY INC
Entity Type:Organization
Organization Name:DE LA ROSA PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:EFRAIN
Authorized Official - Last Name:DELAROSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-968-8995
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:956-565-0251
Mailing Address - Fax:956-565-0252
Practice Address - Street 1:524 W 2ND ST
Practice Address - Street 2:
Practice Address - City:MERCEDES
Practice Address - State:TX
Practice Address - Zip Code:78570-2602
Practice Address - Country:US
Practice Address - Phone:956-565-0251
Practice Address - Fax:956-565-0252
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DE LAROSA PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-16
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX229863336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX156352001Medicaid
TX4533180OtherNABP
TX156352002Medicaid
TX22986OtherSTATE LICENSE
TX156352001Medicaid
TX22986OtherSTATE LICENSE