Provider Demographics
NPI:1972595486
Name:KERRVILLE DRUG CO., INC
Entity type:Organization
Organization Name:KERRVILLE DRUG CO., INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP/PIC
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-895-3784
Mailing Address - Street 1:1050 JUNCTION HWY
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-4902
Mailing Address - Country:US
Mailing Address - Phone:830-895-3784
Mailing Address - Fax:830-895-4412
Practice Address - Street 1:1050 JUNCTION HWY
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-4902
Practice Address - Country:US
Practice Address - Phone:830-895-2273
Practice Address - Fax:830-895-2769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-19
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX049253336C0003X, 3336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150547Medicaid
4524624OtherNCPDP NUMBER
4524624OtherNCPDP NUMBER
TXAK9229445OtherDEA LICENSE #