Provider Demographics
NPI:1194877456
Name:UNIVERSITY PHARMACY LLC
Entity type:Organization
Organization Name:UNIVERSITY PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:CECILIO
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:956-961-4870
Mailing Address - Street 1:1205 N RAUL LONGORIA RD
Mailing Address - Street 2:STE F
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-3720
Mailing Address - Country:US
Mailing Address - Phone:956-961-4870
Mailing Address - Fax:956-961-4470
Practice Address - Street 1:1205 N RAUL LONGORIA RD
Practice Address - Street 2:STE F
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589
Practice Address - Country:US
Practice Address - Phone:956-961-4870
Practice Address - Fax:956-961-4470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX291113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2142907OtherPK
TX4505496OtherNCPDP NUMBER