Provider Demographics
NPI:1003951633
Name:CARSAN INC
Entity Type:Organization
Organization Name:CARSAN INC
Other - Org Name:MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THIRD PARTY PLAN COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:DENA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-993-6000
Mailing Address - Street 1:8111 CYPRESSWOOD DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-7185
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8111 CYPRESSWOOD DR
Practice Address - Street 2:SUITE 107
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-7185
Practice Address - Country:US
Practice Address - Phone:281-655-0110
Practice Address - Fax:281-655-0045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX182113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144635Medicaid
4501498OtherOTHER ID NUMBER-COMMERCIAL NUMBER
4501498OtherOTHER ID NUMBER