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General NPI Number Information
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NPI Number | 1245765445
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Entity Type | Organization
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Legal Business Name | BROWNSVILLE PHARMACY 4 LLC
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Dates
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Enumeration Date | 04/25/2017
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Last Update Date | 03/31/2018
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Provider Practice Location Address
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Address Line | 3503 BOCA CHICA BLVD SUITE #1
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City | BROWNSVILLE
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State | TX
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Zip | 78521-4057
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Country | US
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Telephone | 956-621-1000
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Fax | 956-621-0037
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Provider Business Mailing Address
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Address Line | 3503 BOCA CHICA BLVD
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City | BROWNSVILLE
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State | TX
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Zip | 78521-4057
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Country | US
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Telephone | 956-621-1000
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Fax | 956-621-0037
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | SRINIVASA TALLA
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Credential |
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Telephone | 956-621-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 31376
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 31376
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License Number State | TX
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