Provider Demographics
NPI:1669582706
Name:ACOSTA/MUNIZ RIO GRANDE PHARMACY
Entity type:Organization
Organization Name:ACOSTA/MUNIZ RIO GRANDE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DME MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADOLFO
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-423-1753
Mailing Address - Street 1:1117 S COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-7706
Mailing Address - Country:US
Mailing Address - Phone:956-423-1753
Mailing Address - Fax:956-423-2955
Practice Address - Street 1:1117 S COMMERCE ST
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-7706
Practice Address - Country:US
Practice Address - Phone:956-423-1753
Practice Address - Fax:956-423-2955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0481410001Medicare ID - Type UnspecifiedMEDICARE