Provider Demographics
NPI:1841227246
Name:OSCAR ROSA
Entity Type:Organization
Organization Name:OSCAR ROSA
Other - Org Name:OSCARS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:956-488-8700
Mailing Address - Street 1:5322 E HWY 83
Mailing Address - Street 2:BLDG C SPACE 1
Mailing Address - City:RIO GRANDE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78582-9461
Mailing Address - Country:US
Mailing Address - Phone:956-488-8700
Mailing Address - Fax:956-488-1728
Practice Address - Street 1:5322 E HWY 83
Practice Address - Street 2:BLDG C SPACE 1
Practice Address - City:RIO GRANDE CITY
Practice Address - State:TX
Practice Address - Zip Code:78582-9461
Practice Address - Country:US
Practice Address - Phone:956-488-8700
Practice Address - Fax:956-488-1728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
TX194383336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144828Medicaid
4508531OtherNCPDP PROVIDER IDENTIFICATION NUMBER
4508531OtherNCPDP PROVIDER IDENTIFICATION NUMBER