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General NPI Number Information
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NPI Number | 1235550815
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Entity Type | Organization
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Legal Business Name | SPCSA PLLC
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Dates
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Enumeration Date | 12/26/2013
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 3903 WISEMAN BLVD STE 101
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City | SAN ANTONIO
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State | TX
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Zip | 78251-4402
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Country | US
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Telephone | 210-441-4501
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Fax | 210-441-4502
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Provider Business Mailing Address
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Address Line | 3903 WISEMAN BLVD STE 101
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City | SAN ANTONIO
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State | TX
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Zip | 78251-4402
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Country | US
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Telephone | 210-441-4501
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Fax | 210-441-4502
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Authorized Official
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Title or Position | PHARMACY DIRECTOR
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Name | CHRISTINA MARIE BAKER HICKERSON
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Credential | PHARMACIST
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Telephone | 210-448-9080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 28946
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License Number State | TX
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