Provider Demographics
NPI:1518148022
Name:LONESTAR RX LAS MILPAS
Entity Type:Organization
Organization Name:LONESTAR RX LAS MILPAS
Other - Org Name:MAC PHARMACY SERVICE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCO
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRANZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-514-5051
Mailing Address - Street 1:365 N MISSOURI AVE
Mailing Address - Street 2:
Mailing Address - City:MERCEDES
Mailing Address - State:TX
Mailing Address - Zip Code:78570-2657
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6901 S CAGE BLVD
Practice Address - Street 2:STE F
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-8675
Practice Address - Country:US
Practice Address - Phone:956-702-3491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX257853336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4546365OtherOTHER ID NUMBER