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	3336C0003X	Community/Retail Pharmacy	06492	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4510954	OTHER	TX	NCPDP NUMBER

General Provider Information

NPI Number	:	1932214111
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	:	210-922-2176
Fax Number	:	210-927-4604

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	:	210-927-4604

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RAYMOND ROLAND CARVAJAL
Credential	:	R.PH
Telephone Number	:	210-922-2176

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	04/21/2021

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