MEDICARE: SANITAS RX PHARMACY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy

General Provider Information

NPI Number	:	1063287811
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANITAS RX PHARMACY LLC

Provider Business Mailing Address
First Line	:	1738 ROCK PRAIRIE RD
Second Line	:
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-5900
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1738 ROCK PRAIRIE RD
Second Line	:
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-5900
Country	:	US
Telephone Number	:	979-485-2280
Fax Number	:

Authorized Official
Title or Position	:	OFFICER
Name	:	DEMETRIA SMITH
Credential	:
Telephone Number	:	979-485-2280

Provider Enumeration Date	:	11/21/2023
Last Update Date	:	11/21/2023

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Directions to “SANITAS RX PHARMACY LLC ” Practice Location

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