Provider Demographics
NPI:1841314101
Name:RUSH PHARMACY LLC
Entity type:Organization
Organization Name:RUSH PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AGUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:956-802-1288
Mailing Address - Street 1:2001 S CYNTHIA ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1278
Mailing Address - Country:US
Mailing Address - Phone:956-661-8800
Mailing Address - Fax:956-661-8801
Practice Address - Street 1:2001 S CYNTHIA ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1278
Practice Address - Country:US
Practice Address - Phone:956-661-8800
Practice Address - Fax:956-661-8801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X, 332B00000X
TX264553336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145452Medicaid
TX164084903Medicaid
4504381OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TX164084901Medicaid
TX164084902Medicaid
4504381OtherNCPDP PROVIDER IDENTIFICATION NUMBER