Provider Demographics
NPI:1679731004
Name:YZANLO
Entity Type:Organization
Organization Name:YZANLO
Other - Org Name:JUNIOR'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / PIC
Authorized Official - Prefix:
Authorized Official - First Name:DAMASO
Authorized Official - Middle Name:
Authorized Official - Last Name:NAVARRO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:956-383-4441
Mailing Address - Street 1:1313 S CLOSNER BLVD STE B
Mailing Address - Street 2:SUITE B
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-5665
Mailing Address - Country:US
Mailing Address - Phone:956-383-4441
Mailing Address - Fax:956-383-4448
Practice Address - Street 1:1313 S CLOSNER BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-5665
Practice Address - Country:US
Practice Address - Phone:956-383-4441
Practice Address - Fax:956-383-4448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX260343336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2101301OtherPK
TX145921Medicaid