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General NPI Number Information
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NPI Number | 1174962534
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Entity Type | Organization
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Legal Business Name | TRANS PECOS PHARMACY LLC
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Dates
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Enumeration Date | 06/19/2013
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Last Update Date | 07/22/2013
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Provider Practice Location Address
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Address Line | 724 S EDDY ST
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City | PECOS
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State | TX
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Zip | 79772-3727
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Country | US
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Telephone | 432-445-4916
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Fax | 432-445-6085
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Provider Business Mailing Address
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Address Line | 724 S EDDY ST
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City | PECOS
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State | TX
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Zip | 79772-3727
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Country | US
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Telephone | 432-445-4916
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Fax | 432-445-6085
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Authorized Official
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Title or Position | MEMBER
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Name | STEVE VALENZUELA
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Credential |
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Telephone | 432-445-4916
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 28580
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License Number State | TX
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