MEDICARE: J & A MEDICAL CENTER PHARMACY 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	333600000X	Pharmacy	18866	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4505016	OTHER	TX	NABP NUMBER
2	18866	OTHER	TX	PHARMACY PERMIT

General Provider Information

NPI Number	:	1477549186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J & A MEDICAL CENTER PHARMACY LLC

Provider Business Mailing Address
First Line	:	PO BOX 160
Second Line	:
City	:	ZAPATA
State	:	TX
Zip	:	78076-0160
Country	:	US
Telephone Number	:	956-765-1123
Fax Number	:	956-765-3178

Provider Business Practice Location Address
First Line	:	101 1ST ST.
Second Line	:
City	:	ZAPATA
State	:	TX
Zip	:	78076
Country	:	US
Telephone Number	:	956-765-1123
Fax Number	:	956-765-3178

Authorized Official
Title or Position	:	OWNER-PHARMACIST
Name	:	JUDY G ALEXANDER
Credential	:	RPH
Telephone Number	:	956-717-3839

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	03/07/2023

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