MEDICARE: CARVAJALS 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

General Provider Information

NPI Number	:	1457048746
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARVAJALS INC.

Provider Business Mailing Address
First Line	:	3410 ROOSEVELT AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78214-2606
Country	:	US
Telephone Number	:	210-977-1852
Fax Number	:

Provider Business Practice Location Address
First Line	:	3410 ROOSEVELT AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78214-2606
Country	:	US
Telephone Number	:	210-922-2176
Fax Number	:	210-780-6002

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RAYMOND CARVAJAL
Credential	:	R.PH.
Telephone Number	:	210-977-1852

Provider Enumeration Date	:	04/18/2023
Last Update Date	:	04/18/2023

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