Provider Demographics
NPI:1336875301
Name:SAN CARLOS PHARMACY LLC
Entity Type:Organization
Organization Name:SAN CARLOS PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:VELA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:956-603-2088
Mailing Address - Street 1:8325 EAST STATE HIGHWAY 107
Mailing Address - Street 2:STE 1
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78542
Mailing Address - Country:US
Mailing Address - Phone:956-603-2088
Mailing Address - Fax:956-603-2074
Practice Address - Street 1:8325 EAST STATE HIGHWAY 107
Practice Address - Street 2:STE 1
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78542
Practice Address - Country:US
Practice Address - Phone:956-603-2088
Practice Address - Fax:956-603-2074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-01
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX34380OtherTEXAS STATE BOARD OF PHARMACY