Healthcare Provider Details

I. General information

NPI: 1144527565
Provider Name (Legal Business Name): SOUTHLAND PHARMACY #2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2011
Last Update Date: 02/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4209 N CONWAY AVE STE C
PALMHURST TX
78573-1482
US

IV. Provider business mailing address

4209 N CONWAY AVE STE C
PALMHURST TX
78573-1482
US

V. Phone/Fax

Practice location:
  • Phone: 956-581-7455
  • Fax: 956-581-7464
Mailing address:
  • Phone: 956-581-7455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MRS. VERONICA RAMIREZ
Title or Position: PRESIDENT
Credential: RPH
Phone: 956-583-7845