Provider Demographics
NPI:1881739894
Name:MUNIZ RIO GRANDE PHARMACY LLC
Entity type:Organization
Organization Name:MUNIZ RIO GRANDE PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ROBERTO
Authorized Official - Last Name:MUNIZ
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:2007-02-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X, 3336C0004X, 3336M0002X
TX269523336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4557774OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TX146206Medicaid