Provider Demographics
NPI:1992264246
Name:FARMACIA LA UNICA INC LLC
Entity type:Organization
Organization Name:FARMACIA LA UNICA INC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:RUTHERFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:346-571-8139
Mailing Address - Street 1:7002 RIVERBROOK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-6531
Mailing Address - Country:US
Mailing Address - Phone:832-800-2321
Mailing Address - Fax:281-697-4086
Practice Address - Street 1:7002 RIVERBROOK DR STE 100
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-6531
Practice Address - Country:US
Practice Address - Phone:832-800-2321
Practice Address - Fax:281-697-4086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150327Medicaid