Provider Demographics
NPI:1790845683
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:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:RAQUEL
Authorized Official - Middle Name:NONE
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-357-0408
Mailing Address - Street 1:100 N TEXAS AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MERCEDES
Mailing Address - State:TX
Mailing Address - Zip Code:78570-2723
Mailing Address - Country:US
Mailing Address - Phone:956-514-2420
Mailing Address - Fax:956-514-2530
Practice Address - Street 1:100 N TEXAS AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MERCEDES
Practice Address - State:TX
Practice Address - Zip Code:78570-2723
Practice Address - Country:US
Practice Address - Phone:956-514-2420
Practice Address - Fax:956-514-2530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX222723336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145224Medicaid