Provider Demographics
NPI:1619188448
Name:COACH'S RX INC
Entity Type:Organization
Organization Name:COACH'S RX INC
Other - Org Name:COACH'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORP SEC
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAQUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-514-2420
Mailing Address - Street 1:100 N TX AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MERCEDES
Mailing Address - State:TX
Mailing Address - Zip Code:78570-2747
Mailing Address - Country:US
Mailing Address - Phone:956-514-2420
Mailing Address - Fax:
Practice Address - Street 1:100 N TX AVENUE
Practice Address - Street 2:SUITE A
Practice Address - City:MERCEDES
Practice Address - State:TX
Practice Address - Zip Code:78570-2747
Practice Address - Country:US
Practice Address - Phone:956-514-2420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22272332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154464501Medicaid
TX154464502Medicaid
TX154464502Medicaid