MEDICARE: MEDCENTRIX 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	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	32875	OTHER	TX	TEXAS STATE BOARD OF PHARMACY

General Provider Information

NPI Number	:	1093366106
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDCENTRIX PHARMACY, LLC

Provider Business Mailing Address
First Line	:	5720 BANDERA RD STE 4B
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238-1950
Country	:	US
Telephone Number	:	210-888-8284
Fax Number	:	281-888-8284

Provider Business Practice Location Address
First Line	:	5720 BANDERA RD STE 4B
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238-1950
Country	:	US
Telephone Number	:	210-888-8284
Fax Number	:	281-888-8284

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	APRIL MEEKINS
Credential	:
Telephone Number	:	210-888-8284

Provider Enumeration Date	:	09/20/2019
Last Update Date	:	07/10/2020

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