Healthcare Provider Details

I. General information

NPI: 1326031469
Provider Name (Legal Business Name): JOSE GILBERTO TOVAR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 11/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5203 SOUTH MCCOLL RD.
EDINBURG TX
78539
US

IV. Provider business mailing address

5203 SOUTH MCCOLL RD
EDINBURG TX
78539
US

V. Phone/Fax

Practice location:
  • Phone: 956-687-6204
  • Fax: 956-687-2244
Mailing address:
  • Phone: 956-687-6204
  • Fax: 956-687-2244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number13413
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number13413
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number13413
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number13413
License Number StateTX

VIII. Authorized Official

Name: MR. JOSE GILBERTO TOVAR
Title or Position: PHARMACIST IN CHARGE
Credential: R.PH.
Phone: 956-687-6204