Provider Demographics
NPI:1194156778
Name:INVERNESS APOTHECARY - SOUTH TEXAS
Entity type:Organization
Organization Name:INVERNESS APOTHECARY - SOUTH TEXAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-204-2521
Mailing Address - Street 1:5009 S MCCOLL RD STE A
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-8014
Mailing Address - Country:US
Mailing Address - Phone:956-467-0264
Mailing Address - Fax:956-688-8967
Practice Address - Street 1:5009 S MCCOLL RD STE A
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-8014
Practice Address - Country:US
Practice Address - Phone:956-467-0264
Practice Address - Fax:956-688-8967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-06
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX289213336C0003X
TN54993336C0003X
AL1144063336C0003X
AZY0059243336C0004X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2143518OtherPK