Healthcare Provider Details

I. General information

NPI: 1841227246
Provider Name (Legal Business Name): OSCAR ROSA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 03/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5322 E HWY 83 BLDG C SPACE 1
RIO GRANDE CITY TX
78582-9461
US

IV. Provider business mailing address

5322 E HWY 83 BLDG C SPACE 1
RIO GRANDE CITY TX
78582-9461
US

V. Phone/Fax

Practice location:
  • Phone: 956-488-8700
  • Fax: 956-488-1728
Mailing address:
  • Phone: 956-488-8700
  • Fax: 956-488-1728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number19438
License Number StateTX

VIII. Authorized Official

Name: OSCAR ROSA
Title or Position: OWNER
Credential: RPH
Phone: 956-488-8700