Healthcare Provider Details

I. General information

NPI: 1780925420
Provider Name (Legal Business Name): AMBER RAE MOKRY R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2013
Last Update Date: 03/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4821 BROADWAY ST
SAN ANTONIO TX
78209-5703
US

IV. Provider business mailing address

4821 BROADWAY ST
SAN ANTONIO TX
78209-5703
US

V. Phone/Fax

Practice location:
  • Phone: 210-824-0515
  • Fax: 210-805-8951
Mailing address:
  • Phone: 210-824-0515
  • Fax: 210-805-8951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number46367
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: