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General NPI Number Information
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NPI Number | 1144241118
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Entity Type | Organization
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Legal Business Name | PUERTO RICO PHARMACY INC
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 07/02/2014
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Provider Practice Location Address
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Address Line | 1116 E 8TH ST SUITE 1
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City | WESLACO
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State | TX
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Zip | 78596-7288
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Country | US
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Telephone | 956-968-7733
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Fax | 956-968-9802
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Provider Business Mailing Address
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Address Line | 1116 E 8TH ST SUITE 1
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City | WESLACO
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State | TX
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Zip | 78596-7288
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Country | US
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Telephone | 956-968-7733
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Fax | 956-968-9802
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | BRUCE GINGRICH
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Credential |
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Telephone | 281-232-3940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 24496
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License Number State | TX
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