Provider Demographics
NPI:1831112648
Name:RIOS, JESUS JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:JESUS
Middle Name:
Last Name:RIOS
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2945
Mailing Address - Street 2:
Mailing Address - City:ROMA
Mailing Address - State:TX
Mailing Address - Zip Code:78584-2945
Mailing Address - Country:US
Mailing Address - Phone:195-684-9181
Mailing Address - Fax:
Practice Address - Street 1:708 N GRANT ST
Practice Address - Street 2:
Practice Address - City:ROMA
Practice Address - State:TX
Practice Address - Zip Code:78584-5310
Practice Address - Country:US
Practice Address - Phone:956-849-1811
Practice Address - Fax:956-849-3843
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36840333600000X, 183500000X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX36840OtherPHARMACY LICENSE