Provider Demographics
NPI:1922356708
Name:LAMRX LLC
Entity Type:Organization
Organization Name:LAMRX LLC
Other - Org Name:RIVERSIDE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ESPERICUETA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:956-638-1769
Mailing Address - Street 1:404 S VETERANS BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-4716
Mailing Address - Country:US
Mailing Address - Phone:956-316-3588
Mailing Address - Fax:956-316-3598
Practice Address - Street 1:404 S VETERANS BLVD STE C
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-4721
Practice Address - Country:US
Practice Address - Phone:956-316-3588
Practice Address - Fax:956-316-3598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-27
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
TX280943336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5906803OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TX146654Medicaid