Healthcare Provider Details

I. General information

NPI: 1831112648
Provider Name (Legal Business Name): JESUS RIOS JR. R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 06/16/2022
Certification Date: 03/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 N GRANT ST
ROMA TX
78584-5310
US

IV. Provider business mailing address

PO BOX 2945
ROMA TX
78584-2945
US

V. Phone/Fax

Practice location:
  • Phone: 956-849-1811
  • Fax: 956-849-3843
Mailing address:
  • Phone: 195-684-9181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number36840
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number36840
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: