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General NPI Number Information
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NPI Number | 1871074740
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Entity Type | Organization
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Legal Business Name | BABCOCK PHARMACY LLC
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Dates
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Enumeration Date | 08/28/2018
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Last Update Date | 10/21/2020
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Provider Practice Location Address
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Address Line | 2425 BABCOCK RD STE 108A
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City | SAN ANTONIO
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State | TX
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Zip | 78229-4899
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Country | US
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Telephone | 210-298-9000
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Fax | 210-298-9001
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Provider Business Mailing Address
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Address Line | 2425 BABCOCK RD STE 108A
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City | SAN ANTONIO
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State | TX
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Zip | 78229-4899
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Country | US
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Telephone | 210-298-9000
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Fax | 210-298-9001
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Authorized Official
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Title or Position | VP OF OPERATIONS
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Name | DUDLEY ILES KLATT II
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Credential | PHARM.D.
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Telephone | 210-298-9000
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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 | 32121
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License Number State | TX
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