Provider Demographics
NPI:1427813773
Name:JOSEPHAT ESCOBEDO
Entity type:Organization
Organization Name:JOSEPHAT ESCOBEDO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPHAT
Authorized Official - Middle Name:
Authorized Official - Last Name:ESCOBEDO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:956-465-5121
Mailing Address - Street 1:1205 SANTA ANA AVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO VIEJO
Mailing Address - State:TX
Mailing Address - Zip Code:78575-9755
Mailing Address - Country:US
Mailing Address - Phone:956-465-5121
Mailing Address - Fax:
Practice Address - Street 1:4430 E 14TH ST UNIT B
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-3364
Practice Address - Country:US
Practice Address - Phone:956-983-0707
Practice Address - Fax:956-986-0770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX016917901Medicaid
TX091592801OtherTPI NUMBER