Provider Demographics
NPI:1639270770
Name:VELACORP PHARMACISTS INC
Entity Type:Organization
Organization Name:VELACORP PHARMACISTS INC
Other - Org Name:SAN JUAN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:AGEUDO
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:956-782-6337
Mailing Address - Street 1:1205 N RAUL LONGORIA RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-3720
Mailing Address - Country:US
Mailing Address - Phone:956-782-6337
Mailing Address - Fax:956-588-4314
Practice Address - Street 1:1205 N RAUL LONGORIA RD
Practice Address - Street 2:SUITE F
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589-3720
Practice Address - Country:US
Practice Address - Phone:956-782-6337
Practice Address - Fax:956-588-4314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX011219501Medicaid
TX011219501Medicaid