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General NPI Number Information
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NPI Number | 1225199292
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Entity Type | Organization
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Legal Business Name | JERRY'S PHARMACY, LTD
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 02/16/2010
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Provider Practice Location Address
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Address Line | 2793 MAIN ST
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City | INGLESIDE
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State | TX
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Zip | 78362-5901
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Country | US
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Telephone | 361-776-2577
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Fax | 361-776-0967
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Provider Business Mailing Address
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Address Line | 2793 MAIN ST
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City | INGLESIDE
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State | TX
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Zip | 78362-5901
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Country | US
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Telephone | 361-776-2577
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Fax | 361-776-0967
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Authorized Official
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Title or Position | PHARMACIST, OWNER
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Name | MR. JERRY SMOLIK
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Credential | RPH
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Telephone | 361-776-2577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 23292
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 25909
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License Number State | TX
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