Healthcare Provider Details

I. General information

NPI: 1336634385
Provider Name (Legal Business Name): SPRING BRANCH PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2018
Last Update Date: 06/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17130 HIGHWAY 46 W STE 1
SPRING BRANCH TX
78070-7093
US

IV. Provider business mailing address

PO BOX 1232
SPRING BRANCH TX
78070-1232
US

V. Phone/Fax

Practice location:
  • Phone: 830-885-7770
  • Fax:
Mailing address:
  • Phone: 830-885-7770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number32128
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number32128
License Number StateTX

VIII. Authorized Official

Name: KATHERINE SARAH FISCHER
Title or Position: OWNER
Credential: PHARMD
Phone: 830-885-7770