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
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	26414	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2122660	OTHER		PK

General Provider Information

NPI Number	:	1669518783
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	:	361-575-4488

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	:	361-575-4488

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

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	08/04/2016

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Directions to “CASTLE HILLS PHARMACY LLC ” Practice Location

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