=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356667968
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MUNIZ RIO GRANDE PHARMACY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2010
-----------------------------------------------------
Last Update Date | 02/15/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1117 S COMMERCE ST
-----------------------------------------------------
City | HARLINGEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78550-7706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-423-1753
-----------------------------------------------------
Fax | 956-423-2955
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1117 S COMMERCE ST
-----------------------------------------------------
City | HARLINGEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78550-7706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-423-1753
-----------------------------------------------------
Fax | 956-423-2955
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JOSE ROBERTO MUNIZ
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 956-423-1753
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------