MEDICARE: DEERFIELD HEALTHCARE, 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	3336C0004X	Compounding Pharmacy
2	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1679910913
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEERFIELD HEALTHCARE, LLC

Provider Business Mailing Address
First Line	:	100 NE LOOP 410 STE 1500-B
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-4700
Country	:	US
Telephone Number	:	210-714-0130
Fax Number	:	210-634-2818

Provider Business Practice Location Address
First Line	:	100 NE LOOP 410 STE 1500-B
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-4700
Country	:	US
Telephone Number	:	210-714-0130
Fax Number	:	210-634-2818

Authorized Official
Title or Position	:	MANAGING OFFICER
Name	:	REYNALDO LERMA
Credential	:
Telephone Number	:	210-714-0130

Provider Enumeration Date	:	05/28/2013
Last Update Date	:	01/07/2020

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