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NPI Code Detail

MEDICARE: CARVAJAL PHARMACY LTC

MEDICARE: CARVAJAL PHARMACY LTC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1333600000XPharmacy
23336C0003XCommunity/Retail Pharmacy
33336C0004XCompounding Pharmacy
43336H0001XHome Infusion Therapy Pharmacy
53336L0003XLong Term Care Pharmacy31857TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12175907OTHERPK

General Provider Information

NPI Number : 1265549638
Entity Type Code : Organization
Provider Name (Legal Business Name) : CARVAJAL PHARMACY LTC
Provider Business Mailing Address
First Line : 819 S ACME RD
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78237-2707
Country : US
Telephone Number : 210-922-9031
Fax Number : 210-927-5577
Provider Business Practice Location Address
First Line : 819 S ACME RD
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78237-2707
Country : US
Telephone Number : 210-922-9031
Fax Number : 210-927-5577
Authorized Official
Title or Position : ADMIN
Name : LISA MARTINEZ
Credential :
Telephone Number : 210-922-9031
Provider Enumeration Date : 08/23/2006
Last Update Date : 06/12/2024

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Directions to “CARVAJAL PHARMACY LTC ” Practice Location

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