MEDICARE: MR. CIJO C JAMES R.PH

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	1835P1200X	Pharmacotherapy Pharmacist	20919	NC
2	183500000X	Pharmacist	48336	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	48336	OTHER	TX	TEXAS PHARMACIST LICENSE

General Provider Information

NPI Number	:	1669756656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CIJO C JAMES R.PH

Provider Business Mailing Address
First Line	:	2604 SANTA ERICA ST
Second Line	:
City	:	MISSION
State	:	TX
Zip	:	78572-7161
Country	:	US
Telephone Number	:	956-579-5750
Fax Number	:

Provider Business Practice Location Address
First Line	:	5326 E US HIGHWAY
Second Line	:	A 5
City	:	RIO GRANDE CITY
State	:	TX
Zip	:	78582-7858
Country	:	US
Telephone Number	:	956-317-1112
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2011
Last Update Date	:	02/03/2023

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