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NPI Code Detail

MEDICARE: BUENA VISTA PHARMACY, INC

MEDICARE: BUENA VISTA 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
13336C0003XCommunity/Retail Pharmacy25658TX

General Provider Information

NPI Number : 1871783324
Entity Type Code : Organization
Provider Name (Legal Business Name) : BUENA VISTA PHARMACY, INC
Provider Business Mailing Address
First Line : 8920 US HIGHWAY 87 E STE 4A
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78263-2238
Country : US
Telephone Number : 210-648-9001
Fax Number : 210-649-9004
Provider Business Practice Location Address
First Line : 8920 US HIGHWAY 87 E STE 4A
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78263-2238
Country : US
Telephone Number : 210-648-9001
Fax Number : 210-649-9004
Authorized Official
Title or Position : PRESIDENT
Name : MR. RAYMOND D IBANEZ
Credential : RPH
Telephone Number : 210-674-1900
Provider Enumeration Date : 07/31/2007
Last Update Date : 07/31/2007

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Directions to “BUENA VISTA PHARMACY, INC ” Practice Location

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