1336243054 NPI number — FFACTS PHARMACY

Table of content: (NPI 1336243054)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336243054 NPI number — FFACTS PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FFACTS PHARMACY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336243054
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
903 W MARTIN ST
Provider Second Line Business Mailing Address:
C-202
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-358-9660
Provider Business Mailing Address Fax Number:
210-358-9634

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
527 N LEONA ST
Provider Second Line Business Practice Location Address:
C-202
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78207-3110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-358-9660
Provider Business Practice Location Address Fax Number:
210-358-9634
Provider Enumeration Date:
09/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MOTE
Authorized Official First Name:
MARY
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
VICE PRES./CHIEF REVENUE OFFICER
Authorized Official Telephone Number:
210-358-2895

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  23267 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 250478 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4536097 . This is a "NCPDP# (NABP#)" identifier . This identifiers is of the category "OTHER".