Active NPI
Edmundo Vivanco
- Pharmacist
- Horizon City, TX
National Provider Identifier
1609747104
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 75935
- Practice address
- 14300 Horizon Blvd
Horizon City, TX 79928-8527 - Phone
- (915) 852-1561
- NPI assigned
- Sep 16, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 75935 | TX | Primary |
Addresses
Primary practice location
14300 Horizon Blvd
Horizon City, TX 79928-8527
Mailing address
6401 Calle Roja
El Paso, TX 79912-3423
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 75935 | TX | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
14300 Horizon Blvd
Horizon City, TX 79928
Phone (915) 852-1561
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pharmacy
- Horizon City, TX
- NPI 1952588469
-
- Pharmacy
- Longview, TX
- NPI 1629956545
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1757980800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757980800000",
"number": "1609747104",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6401 CALLE ROJA",
"city": "EL PASO",
"state": "TX",
"postal_code": "799123423"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14300 HORIZON BLVD",
"city": "HORIZON CITY",
"state": "TX",
"postal_code": "799288527",
"telephone_number": "915-852-1561"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VIVANCO",
"first_name": "EDMUNDO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-09-16",
"last_updated": "2025-09-16",
"certification_date": "2025-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "75935",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Horizon City, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.