Provider Demographics
NPI:1619193596
Name:LA BLANCA PHARMACY INC.
Entity Type:Organization
Organization Name:LA BLANCA PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:RICARDO
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:956-262-7662
Mailing Address - Street 1:2801 S PECAN BLVD
Mailing Address - Street 2:
Mailing Address - City:DONNA
Mailing Address - State:TX
Mailing Address - Zip Code:78537-6553
Mailing Address - Country:US
Mailing Address - Phone:956-262-7662
Mailing Address - Fax:856-262-7627
Practice Address - Street 1:18360 FM 493 STE. B
Practice Address - Street 2:
Practice Address - City:LA BLANCA
Practice Address - State:TX
Practice Address - Zip Code:78558
Practice Address - Country:US
Practice Address - Phone:956-262-7662
Practice Address - Fax:956-262-7627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23203332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies