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General NPI Number Information
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NPI Number | 1467052860
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Entity Type | Individual
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Provider Name | BENJAMIN WADE MCCALIB PHARMD
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Gender | Male
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Dates
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Enumeration Date | 10/27/2020
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Last Update Date | 10/27/2020
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Provider Practice Location Address
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Address Line | 11210 POTRANCO RD
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City | SAN ANTONIO
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State | TX
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Zip | 78253-5844
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Country | US
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Telephone | 210-679-9208
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Fax |
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Provider Business Mailing Address
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Address Line | 3010 W LOOP 1604 N APT 2308
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City | SAN ANTONIO
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State | TX
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Zip | 78251-3908
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Country | US
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Telephone | 281-546-9707
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 55051
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License Number State | TX
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