MEDICARE: PHARMACY CARE USA OF WESLACO, 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	3336C0003X	Community/Retail Pharmacy	26743	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2141692	OTHER		PK

General Provider Information

NPI Number	:	1457785305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHARMACY CARE USA OF WESLACO, LLC

Provider Business Mailing Address
First Line	:	PO BOX 295
Second Line	:
City	:	HYDRO
State	:	OK
Zip	:	73048-0295
Country	:	US
Telephone Number	:	405-663-4111
Fax Number	:	405-663-4114

Provider Business Practice Location Address
First Line	:	2202 SUGAR SWEET STE E
Second Line	:
City	:	WESLACO
State	:	TX
Zip	:	78599-3760
Country	:	US
Telephone Number	:	956-968-4300
Fax Number	:	956-968-7117

Authorized Official
Title or Position	:	MANAGER
Name	:	BARNEY ABBOTT
Credential	:
Telephone Number	:	866-403-2003

Provider Enumeration Date	:	08/28/2013
Last Update Date	:	08/28/2013

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