Provider Demographics
NPI:1588876478
Name:SANTA MARIA PHARMACY, INC.
Entity type:Organization
Organization Name:SANTA MARIA PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:VALENTINE
Authorized Official - Last Name:OGBA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:956-569-7965
Mailing Address - Street 1:1222 W MONTE CRISTO RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78541-3873
Mailing Address - Country:US
Mailing Address - Phone:956-383-7709
Mailing Address - Fax:956-383-7901
Practice Address - Street 1:1222 W MONTE CRISTO RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78541-3873
Practice Address - Country:US
Practice Address - Phone:956-383-7709
Practice Address - Fax:956-383-7901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX254903336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145993Medicaid
TX145993Medicaid