Provider Demographics
NPI:1598184004
Name:MAHADEV RX LLC
Entity Type:Organization
Organization Name:MAHADEV RX LLC
Other - Org Name:JOURDANTON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NARENDER
Authorized Official - Middle Name:
Authorized Official - Last Name:BANGLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-770-0770
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:JOURDANTON
Mailing Address - State:TX
Mailing Address - Zip Code:78026-0189
Mailing Address - Country:US
Mailing Address - Phone:830-770-0770
Mailing Address - Fax:830-770-0973
Practice Address - Street 1:1810 HIGHWAY 97 E
Practice Address - Street 2:
Practice Address - City:JOURDANTON
Practice Address - State:TX
Practice Address - Zip Code:78026-1521
Practice Address - Country:US
Practice Address - Phone:830-770-0770
Practice Address - Fax:830-770-0973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-11
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX291373336C0003X
3336C0003X, 3336C0004X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148086Medicaid