Provider Demographics
NPI:1962612937
Name:MOMS PHARMACIES INC
Entity type:Organization
Organization Name:MOMS PHARMACIES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUILERA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:956-227-9417
Mailing Address - Street 1:PO BOX 4226
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-4226
Mailing Address - Country:US
Mailing Address - Phone:956-584-8885
Mailing Address - Fax:
Practice Address - Street 1:1501 E BUSINESS 83
Practice Address - Street 2:STE A
Practice Address - City:DONNA
Practice Address - State:TX
Practice Address - Zip Code:78537-3449
Practice Address - Country:US
Practice Address - Phone:956-461-5800
Practice Address - Fax:956-461-5814
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOM'S PHARMACIES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-22
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX255413336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4544931OtherNCPDP
TXDO151961OtherTEXAS CONTROLLED SUBSTANC
TX25541OtherTEXAS STATE BOARD OF PHA