Provider Demographics
NPI:1386789956
Name:GADDIS PHARMACY LC
Entity type:Organization
Organization Name:GADDIS PHARMACY LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOAQUIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-879-2323
Mailing Address - Street 1:302 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COTULLA
Mailing Address - State:TX
Mailing Address - Zip Code:78014-2153
Mailing Address - Country:US
Mailing Address - Phone:830-879-2323
Mailing Address - Fax:830-879-3260
Practice Address - Street 1:302 N MAIN ST
Practice Address - Street 2:
Practice Address - City:COTULLA
Practice Address - State:TX
Practice Address - Zip Code:78014-2153
Practice Address - Country:US
Practice Address - Phone:830-879-2323
Practice Address - Fax:830-879-3260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1229380001Medicare ID - Type Unspecified