MEDICARE: LAREDO DOWNTOWN PHARMACY, INC.

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	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1417586645
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAREDO DOWNTOWN PHARMACY, INC.

Provider Business Mailing Address
First Line	:	1219 MATAMOROS ST
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78040-5069
Country	:	US
Telephone Number	:	956-726-4512
Fax Number	:	956-726-6506

Provider Business Practice Location Address
First Line	:	1219 MATAMOROS ST
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78040-5069
Country	:	US
Telephone Number	:	956-726-4512
Fax Number	:	956-726-6506

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. TOMAS L IZAGUIRRE
Credential	:
Telephone Number	:	956-726-4512

Provider Enumeration Date	:	04/08/2020
Last Update Date	:	04/08/2020

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