MEDICARE: BORDER RIVER INCORPORATED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0004X	Compounding Pharmacy
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	31878	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2176243	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033610696
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BORDER RIVER INCORPORATED

Provider Business Mailing Address
First Line	:	2504 SANTA ERICA ST
Second Line	:
City	:	MISSION
State	:	TX
Zip	:	78572-7175
Country	:	US
Telephone Number	:	956-579-5750
Fax Number	:

Provider Business Practice Location Address
First Line	:	5326 E US HIGHWAY 83 STE A
Second Line	:
City	:	RIO GRANDE CITY
State	:	TX
Zip	:	78582-9409
Country	:	US
Telephone Number	:	956-317-1112
Fax Number	:	956-317-1113

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	MARY JAMES
Credential	:
Telephone Number	:	956-317-1112

Provider Enumeration Date	:	02/27/2018
Last Update Date	:	02/16/2021

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Directions to “BORDER RIVER INCORPORATED ” Practice Location

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