Healthcare Provider Details

I. General information

NPI: 1184265498
Provider Name (Legal Business Name): MEDCARE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2019
Last Update Date: 07/11/2020
Certification Date: 07/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3712 NEW MATHIS RD STE 1
ELMENDORF TX
78112-6298
US

IV. Provider business mailing address

PO BOX 765
COPPELL TX
75019-0710
US

V. Phone/Fax

Practice location:
  • Phone: 210-794-0099
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MRS. UMA TALLURI
Title or Position: OFFICER
Credential:
Phone: 210-794-0099