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General NPI Number Information
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NPI Number | 1366127748
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Entity Type | Organization
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Legal Business Name | PACSOUTH DISTRIBUTION DELAWARE LLC
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Dates
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Enumeration Date | 06/21/2023
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Last Update Date | 06/21/2023
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Provider Practice Location Address
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Address Line | 4310 WEST AVE
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City | SAN ANTONIO
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State | TX
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Zip | 78213-3033
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Country | US
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Telephone | 210-541-7814
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Fax |
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Provider Business Mailing Address
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Address Line | 4310 WEST AVE
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City | SAN ANTONIO
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State | TX
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Zip | 78213-3033
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Country | US
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Telephone | 210-541-7814
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Fax |
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Authorized Official
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Title or Position | COMPLIANCE OFFICER
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Name | MR. JOHN-DAVID COLLIER
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Credential |
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Telephone | 210-887-7503
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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