Healthcare Provider Details

I. General information

NPI: 1871504423
Provider Name (Legal Business Name): ELSA PHARMACY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 05/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 W EDINBURG DR
ELSA TX
78543
US

IV. Provider business mailing address

PO BOX 429
ELSA TX
78543-0429
US

V. Phone/Fax

Practice location:
  • Phone: 956-262-6400
  • Fax: 956-262-4122
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number25094
License Number StateTX

VIII. Authorized Official

Name: MOISES TORRES
Title or Position: OWNER / PIC / MGR
Credential: RPH
Phone: 956-262-6400