MEDICARE: EPOCH PHARMACY SOLUTIONS SANTE FE MEDICINE MAN PHARMACY

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	3336C0004X	Compounding Pharmacy
4	3336C0003X	Community/Retail Pharmacy	26474	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	2120311	OTHER		PK

General Provider Information

NPI Number	:	1932334588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EPOCH PHARMACY SOLUTIONS SANTE FE MEDICINE MAN PHARMACY

Provider Business Mailing Address
First Line	:	PO BOX 3670
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77903-3670
Country	:	US
Telephone Number	:	361-894-6430
Fax Number	:	361-894-6431

Provider Business Practice Location Address
First Line	:	13250 HIGHWAY 6
Second Line	:
City	:	SANTA FE
State	:	TX
Zip	:	77510-7682
Country	:	US
Telephone Number	:	409-927-1979
Fax Number	:	409-925-7170

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	BRUCE ROGERS
Credential	:
Telephone Number	:	361-894-6430

Provider Enumeration Date	:	05/27/2009
Last Update Date	:	02/15/2016

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Directions to “EPOCH PHARMACY SOLUTIONS SANTE FE MEDICINE MAN PHARMACY ” Practice Location

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