Provider Demographics
NPI:1255443164
Name:GARZA PHARMACY RX, LLC
Entity type:Organization
Organization Name:GARZA PHARMACY RX, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RPH
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:AMADEO
Authorized Official - Last Name:GARZA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:956-399-1411
Mailing Address - Street 1:205 W US HIGHWAY 77
Mailing Address - Street 2:
Mailing Address - City:SAN BENITO
Mailing Address - State:TX
Mailing Address - Zip Code:78586-5143
Mailing Address - Country:US
Mailing Address - Phone:956-399-1411
Mailing Address - Fax:956-399-2401
Practice Address - Street 1:205 W US HIGHWAY 77
Practice Address - Street 2:
Practice Address - City:SAN BENITO
Practice Address - State:TX
Practice Address - Zip Code:78586-5143
Practice Address - Country:US
Practice Address - Phone:956-399-1411
Practice Address - Fax:956-399-2401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X, 3336C0003X
TX04776333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4551784OtherOTHER ID NUMBER-COMMERCIAL NUMBER
TX141674Medicaid
TX1710428Medicaid
TX1255443164OtherNPI
TX141674Medicaid
TXAT9113490OtherDEA #
TX5298840001Medicare NSC