Provider Demographics
NPI:1659391159
Name:L R INC
Entity Type:Organization
Organization Name:L R INC
Other - Org Name:EL RIO FAMILY CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:LEOPOLDO
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:956-723-2001
Mailing Address - Street 1:2100 CORPUS CHRISTI ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-3398
Mailing Address - Country:US
Mailing Address - Phone:956-723-2001
Mailing Address - Fax:956-723-2519
Practice Address - Street 1:2100 CORPUS CHRISTI ST
Practice Address - Street 2:SUITE 9
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78043-3398
Practice Address - Country:US
Practice Address - Phone:956-723-2001
Practice Address - Fax:956-723-2519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX036743336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142403Medicaid
2098124OtherPK
2098124OtherPK