MEDICARE: ALAMO CITY PHARMACY LLC

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	3336C0003X	Community/Retail Pharmacy	29511	TX

General Provider Information

NPI Number	:	1750788329
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALAMO CITY PHARMACY LLC

Provider Business Mailing Address
First Line	:	110 STONE OAK LOOP STE 100
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-3510
Country	:	US
Telephone Number	:	210-268-0153
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 STONE OAK LOOP STE 100
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-3510
Country	:	US
Telephone Number	:	210-268-0153
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. ERNESTO GARZA-GONGORA II
Credential	:	PHARM.D.
Telephone Number	:	210-478-0345

Provider Enumeration Date	:	11/26/2014
Last Update Date	:	11/26/2014

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Directions to “ALAMO CITY PHARMACY LLC ” Practice Location

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