MEDICARE: CASTLE HILLS 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1346480720
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASTLE HILLS PHARMACY LLC

Provider Business Mailing Address
First Line	:	3412 SAM HOUSTON DR
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77904-2238
Country	:	US
Telephone Number	:	361-575-6328
Fax Number	:

Provider Business Practice Location Address
First Line	:	3412 SAM HOUSTON DR
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77904-2238
Country	:	US
Telephone Number	:	361-575-6328
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL LAWRENCE WARD
Credential	:	RPH
Telephone Number	:	361-575-6328

Provider Enumeration Date	:	02/25/2009
Last Update Date	:	03/07/2011

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