MEDICARE: RICHARD'S PHARMACY #2 LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	19061	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164524807
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD'S PHARMACY #2 LLC

Provider Business Mailing Address
First Line	:	909 BUSINESS PARK DR STE 2
Second Line	:
City	:	MISSION
State	:	TX
Zip	:	78572-6054
Country	:	US
Telephone Number	:	956-519-6777
Fax Number	:	956-519-0443

Provider Business Practice Location Address
First Line	:	909 BUSINESS PARK DR STE 2
Second Line	:
City	:	MISSION
State	:	TX
Zip	:	78572-6054
Country	:	US
Telephone Number	:	956-519-6777
Fax Number	:	956-519-0443

Authorized Official
Title or Position	:	OWNER/STAFF PHARMACIST
Name	:	MR. RAMIRO HUMBERTO BARRERA
Credential	:	RPH
Telephone Number	:	956-519-6776

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	08/22/2020

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