Provider Demographics
NPI:1558477380
Name:ALAMO HEALTH LLC
Entity Type:Organization
Organization Name:ALAMO HEALTH LLC
Other - Org Name:QRC HEALTHMART PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RAJESH
Authorized Official - Middle Name:
Authorized Official - Last Name:HAJARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-400-7388
Mailing Address - Street 1:408 US HWY 90
Mailing Address - Street 2:WEST-B
Mailing Address - City:CASTROVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78009-4547
Mailing Address - Country:US
Mailing Address - Phone:830-931-2116
Mailing Address - Fax:830-538-2938
Practice Address - Street 1:408 US HWY 90
Practice Address - Street 2:WEST-B
Practice Address - City:CASTROVILLE
Practice Address - State:TX
Practice Address - Zip Code:78009-4547
Practice Address - Country:US
Practice Address - Phone:830-931-2116
Practice Address - Fax:830-538-2938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX190563336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144770Medicaid
TX19056OtherSTATE BOARD LICENSE
TX4584024OtherNABP