Healthcare Provider Details

I. General information

NPI: 1275855025
Provider Name (Legal Business Name): RGV DOCTORS PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2010
Last Update Date: 02/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 E FM 495
SAN JUAN TX
78589-3710
US

IV. Provider business mailing address

108 E FM 495
SAN JUAN TX
78589-3710
US

V. Phone/Fax

Practice location:
  • Phone: 956-787-1452
  • Fax: 956-213-8135
Mailing address:
  • Phone: 956-787-1452
  • Fax: 956-213-8135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number26793
License Number StateTX

VIII. Authorized Official

Name: LEONEL GUERRERO
Title or Position: PHARMACIST
Credential:
Phone: 956-787-1452