=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902782618
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROBERTO V SALINAS PHARMACY ESOP TR
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2025
-----------------------------------------------------
Last Update Date | 08/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 810 W OCEAN BLVD
-----------------------------------------------------
City | LOS FRESNOS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78566-3600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-233-3400
-----------------------------------------------------
Fax | 956-233-3402
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 810 W OCEAN BLVD
-----------------------------------------------------
City | LOS FRESNOS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78566-3600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-233-3400
-----------------------------------------------------
Fax | 956-233-3402
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST IN CHARGE
-----------------------------------------------------
Name | ROBERT VALENTIN SALINAS
-----------------------------------------------------
Credential | PHARMACIST
-----------------------------------------------------
Telephone | 956-233-3400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------