Provider Demographics
NPI:1871882886
Name:PALOMA'S PHARMACY,LLC
Entity type:Organization
Organization Name:PALOMA'S PHARMACY,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORP-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:VELA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, RPH
Authorized Official - Phone:956-821-2886
Mailing Address - Street 1:909 BUSINESS PARK DR
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-6052
Mailing Address - Country:US
Mailing Address - Phone:956-424-6268
Mailing Address - Fax:956-424-6258
Practice Address - Street 1:909 BUSINESS PARK DR STE 2
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6054
Practice Address - Country:US
Practice Address - Phone:956-424-6268
Practice Address - Fax:956-424-6258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-30
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX274333336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146386Medicaid