Provider Demographics
NPI:1982356457
Name:TIN RX 808, INC.
Entity Type:Organization
Organization Name:TIN RX 808, INC.
Other - Org Name:TIN RX #808
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-928-9168
Mailing Address - Street 1:3403 LOUETTA RD.
Mailing Address - Street 2:SUITE D
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388
Mailing Address - Country:US
Mailing Address - Phone:832-514-3401
Mailing Address - Fax:832-514-3402
Practice Address - Street 1:3403 LOUETTA RD.
Practice Address - Street 2:SUITE D
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388
Practice Address - Country:US
Practice Address - Phone:832-514-3401
Practice Address - Fax:832-514-3402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-25
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX468554Medicaid