Provider Demographics
NPI:1982230488
Name:RIO GRANDE PHARMACY, LLC
Entity Type:Organization
Organization Name:RIO GRANDE PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MGR
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:H
Authorized Official - Last Name:SALCIDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-260-8555
Mailing Address - Street 1:5500 DONIPHAN DR STE 201-202
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79932-1454
Mailing Address - Country:US
Mailing Address - Phone:915-260-8555
Mailing Address - Fax:915-304-0374
Practice Address - Street 1:5500 DONIPHAN DR STE 201-202
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79932-1454
Practice Address - Country:US
Practice Address - Phone:915-260-8555
Practice Address - Fax:915-304-0374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy