MEDICARE: R & R COMPOUNDING 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	3336S0011X	Specialty Pharmacy
2	3336C0003X	Community/Retail Pharmacy
3	333600000X	Pharmacy	22267	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2160643	OTHER		PK

General Provider Information

NPI Number	:	1962681007
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	R & R COMPOUNDING PHARMACY LLC

Provider Business Mailing Address
First Line	:	2950 THOUSAND OAKS DR
Second Line	:	SUITE 25
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-3361
Country	:	US
Telephone Number	:	210-424-0025
Fax Number	:	210-424-0026

Provider Business Practice Location Address
First Line	:	2950 THOUSAND OAKS DR
Second Line	:	SUITE 25
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-3361
Country	:	US
Telephone Number	:	210-424-0025
Fax Number	:	210-424-0026

Authorized Official
Title or Position	:	OWNER
Name	:	RONDA WENZEL
Credential	:
Telephone Number	:	210-424-0025

Provider Enumeration Date	:	10/25/2007
Last Update Date	:	07/13/2016

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