Provider Demographics
NPI:1922130632
Name:DE LA ROSA PHARMACY INC
Entity Type:Organization
Organization Name:DE LA ROSA PHARMACY INC
Other - Org Name:DE LA ROSA PHARMACY & MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.E.O. OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:EFRAIN
Authorized Official - Last Name:DE LA ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-968-8995
Mailing Address - Street 1:1500 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-6606
Mailing Address - Country:US
Mailing Address - Phone:956-968-8995
Mailing Address - Fax:956-969-5728
Practice Address - Street 1:1500 E 6TH ST
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6606
Practice Address - Country:US
Practice Address - Phone:956-968-8995
Practice Address - Fax:956-969-5728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12051332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX12051OtherST LICENSE
TX4573879OtherNABP
TX530338OtherBCBS PROVIDER NUMBER
TX7442447456OtherTAX ID
TX7442447456OtherTAX ID
TX4573879OtherNABP
TX12051OtherST LICENSE