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General NPI Number Information
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NPI Number | 1932678646
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Entity Type | Organization
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Legal Business Name | DIVINE PHARMACY LLC
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Dates
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Enumeration Date | 11/26/2018
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Last Update Date | 02/01/2022
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Provider Practice Location Address
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Address Line | 427 E DURANTA AVE STE 101
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City | ALAMO
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State | TX
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Zip | 78516-3409
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Country | US
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Telephone | 956-287-4551
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Fax | 956-287-4420
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Provider Business Mailing Address
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Address Line | 427 E DURANTA AVE STE 101
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City | ALAMO
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State | TX
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Zip | 78516-3409
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Country | US
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Telephone | 956-287-4551
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Fax | 956-287-4420
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Authorized Official
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Title or Position | OWNER
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Name | JOSE VARGAS
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Credential |
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Telephone | 956-534-6990
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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 |
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License Number State |
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