Provider Demographics
NPI:1770598302
Name:OSCAR ROSA
Entity type:Organization
Organization Name:OSCAR ROSA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-583-7999
Mailing Address - Street 1:2116 W GRIFFIN PKWY
Mailing Address - Street 2:
Mailing Address - City:PALMVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:78572-9732
Mailing Address - Country:US
Mailing Address - Phone:956-583-7999
Mailing Address - Fax:956-585-6176
Practice Address - Street 1:2116 W GRIFFIN PKWY
Practice Address - Street 2:
Practice Address - City:PALMVIEW
Practice Address - State:TX
Practice Address - Zip Code:78572-9732
Practice Address - Country:US
Practice Address - Phone:956-583-7999
Practice Address - Fax:956-585-6176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
TX200273336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4512768OtherNCPDP PROVIDER IDENTIFICATION NUMBER