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General NPI Number Information
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NPI Number | 1245371012
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Entity Type | Organization
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Legal Business Name | LGFM LTD
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 07/14/2008
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Provider Practice Location Address
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Address Line | 2613 W TRENTON RD
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City | EDINBURG
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State | TX
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Zip | 78539-3432
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Country | US
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Telephone | 956-668-8352
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Fax | 956-664-0308
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Provider Business Mailing Address
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Address Line | 2613 W TRENTON RD
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City | EDINBURG
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State | TX
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Zip | 78539-3432
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Country | US
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Telephone | 956-668-8352
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Fax | 956-664-0308
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Authorized Official
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Title or Position | MANAGER
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Name | MR. LUIS FABIAN VELA
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Credential | RPH
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Telephone | 956-668-8352
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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 | 23321
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License Number State | TX
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