Healthcare Provider Details

I. General information

NPI: 1659629491
Provider Name (Legal Business Name): MSCARTER RX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 08/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3845 SPID DR # B
CORPUS CHRISTI TX
78415-2919
US

IV. Provider business mailing address

3845 SPID DR # B
CORPUS CHRISTI TX
78415-2919
US

V. Phone/Fax

Practice location:
  • Phone: 361-452-2051
  • Fax:
Mailing address:
  • Phone: 361-452-2051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number28337
License Number StateTX

VIII. Authorized Official

Name: MARK CARTER
Title or Position: OWNER
Credential:
Phone: 361-452-2051