Provider Demographics
NPI:1588900393
Name:BROWNSVILLE PHARMACY 2 LLC
Entity type:Organization
Organization Name:BROWNSVILLE PHARMACY 2 LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SRINIVASA
Authorized Official - Middle Name:
Authorized Official - Last Name:TALLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-392-8254
Mailing Address - Street 1:1365 E RUBEN TORRES BLVD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-0964
Mailing Address - Country:US
Mailing Address - Phone:956-542-5100
Mailing Address - Fax:
Practice Address - Street 1:1365 E RUBEN TORRES BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-0964
Practice Address - Country:US
Practice Address - Phone:956-542-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-26
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies