Provider Demographics
NPI:1568822302
Name:PHARMAVIDA RX INC
Entity Type:Organization
Organization Name:PHARMAVIDA RX INC
Other - Org Name:PHARMAVIDA RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RPH, PHARMD/PIC
Authorized Official - Prefix:
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:
Authorized Official - Last Name:MALAGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-563-3361
Mailing Address - Street 1:1337 E PALMA VISTA DR STE B
Mailing Address - Street 2:
Mailing Address - City:PALMVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:78572-2055
Mailing Address - Country:US
Mailing Address - Phone:956-424-6640
Mailing Address - Fax:956-424-6639
Practice Address - Street 1:1337 E PALMA VISTA DR STE B
Practice Address - Street 2:
Practice Address - City:PALMVIEW
Practice Address - State:TX
Practice Address - Zip Code:78572-2055
Practice Address - Country:US
Practice Address - Phone:956-424-6640
Practice Address - Fax:956-424-6639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-04
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30676333600000X
3336C0003X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149306Medicaid
2159255OtherPK