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General NPI Number Information
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NPI Number | 1639524549
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Entity Type | Organization
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Legal Business Name | ANNIE'S APOTHECARY
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Dates
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Enumeration Date | 04/28/2016
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Last Update Date | 04/28/2016
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Provider Practice Location Address
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Address Line | 31007 INTERSTATE 10 W SUITE 108
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City | BOERNE
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State | TX
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Zip | 78006-9264
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Country | US
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Telephone | 830-981-4774
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Fax |
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Provider Business Mailing Address
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Address Line | 31007 INTERSTATE 10 W SUITE 108
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City | BOERNE
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State | TX
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Zip | 78006-9264
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Country | US
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Telephone | 830-981-4774
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Fax |
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | ANDY GRASSO
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Credential |
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Telephone | 830-981-4774
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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 | 54832
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License Number State | TX
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