Organization
MERMAID WALKING INC
Active
Other names
Divine Pharmacy #2
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSE ALBERTO VELA PHARM.D. (PRESIDENT)
(956) 583-2700
Entity
Organization
Contact information
Practice address
409 STATE HWY 495, SAN JUAN, TX 78596
(956) 601-0140
(956) 601-0130
Mailing address
1107 PAMELA DR STE B, MISSION, TX 78572-4340
(956) 583-2700
(956) 583-3220
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
31942
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
149855
—
TX
01
—
2176877
PK
—
Enumeration date
04/10/2018
Last updated
08/12/2024
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