Healthcare Provider Details

I. General information

NPI: 1386789956
Provider Name (Legal Business Name): GADDIS PHARMACY LC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 N MAIN ST
COTULLA TX
78014-2153
US

IV. Provider business mailing address

302 N MAIN ST
COTULLA TX
78014-2153
US

V. Phone/Fax

Practice location:
  • Phone: 830-879-2323
  • Fax: 830-879-3260
Mailing address:
  • Phone: 830-879-2323
  • Fax: 830-879-3260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JOAQUIN CARPENTER
Title or Position: OWNER
Credential:
Phone: 830-879-2323