=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942021522
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LJ PHARMACY RELIEF, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2024
-----------------------------------------------------
Last Update Date | 10/17/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2004 E. EXPRESSWAY 83 SUITE 2
-----------------------------------------------------
City | WESLACO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78599
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-405-3089
-----------------------------------------------------
Fax | 956-405-3178
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19318 WATER BRIDGE DR
-----------------------------------------------------
City | CYPRESS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77433-3176
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-952-9111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. LUCY MATA BARRACHINA
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 469-952-9111
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------