Provider Demographics
NPI:1558696849
Name:TECH MED 1 ENTERPRISES, PLLC
Entity type:Organization
Organization Name:TECH MED 1 ENTERPRISES, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LESLIE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:832-573-7447
Mailing Address - Street 1:230 CONQUEST STE H
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-0227
Mailing Address - Country:US
Mailing Address - Phone:956-305-6767
Mailing Address - Fax:956-305-6768
Practice Address - Street 1:230 CONQUEST STE H
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-0227
Practice Address - Country:US
Practice Address - Phone:956-305-6767
Practice Address - Fax:956-305-6768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-05
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4553992OtherNCPDP PROVIDER IDENTIFICATION NUMBER