MEDICARE: JEFFERSON PHARMACY INC

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
1	3336L0003X	Long Term Care Pharmacy
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	06118	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4530487	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265560528
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFERSON PHARMACY INC

Provider Business Mailing Address
First Line	:	917 MANOR DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78228-3227
Country	:	US
Telephone Number	:	210-734-5133
Fax Number	:	210-735-8815

Provider Business Practice Location Address
First Line	:	917 MANOR DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78228-3227
Country	:	US
Telephone Number	:	210-734-5133
Fax Number	:	210-735-8815

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	KEVIN KENNEDY
Credential	:
Telephone Number	:	210-824-0771

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	10/26/2010

Similar Medicare Providers

1881914000 — GRUPO MEDICO POLICLINICA SAN PEDRO MEDICARE ADVANTAGE
Practice Location Address:

211 CALLE MORSE
ARROYO, PR
00714-2350

Practice Phone: 787-839-3980
Practice Fax: 787-271-2515

1225096365 — DR. DAVID AARON WITTEN PHARM. D
Practice Location Address:

3227 SE MILITARY DR
SAN ANTONIO, TX
78223-3876

Practice Phone: 210-247-0083
Practice Fax: 210-247-0083

1326060096 — CVS PHARMACY INC.
Practice Location Address:

3227 SE MILITARY DR
SAN ANTONIO, TX
78223-3876

Practice Phone: 210-247-0083
Practice Fax: 210-247-0949

1033127022 — CHARLES P BIEDIGER MD
Practice Location Address:

19026 STONE OAK PKWY , SUITE 110
SAN ANTONIO, TX
78258-3227

Practice Phone: 210-545-0404
Practice Fax: 210-614-1003

1083713192 — DR. LYUDMILA VASILIEVNA HARTT M.D.
Practice Location Address:

19026 STONE OAK PKWY , 205
SAN ANTONIO, TX
78258-3227

Practice Phone: 210-495-4085
Practice Fax: 210-495-4086

1295873925 — DR. ANDRE XAVIER SMITH DDS
Practice Location Address:

2606 E HOUSTON ST
SAN ANTONIO, TX
78202-3227

Practice Phone: 210-227-0962
Practice Fax: 210-227-6903

Directions to “JEFFERSON PHARMACY INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.