Provider Demographics
NPI:1063637825
Name:ZARZAMORA PHARMACY, INC.
Entity Type:Organization
Organization Name:ZARZAMORA PHARMACY, INC.
Other - Org Name:BARLITE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, PIC
Authorized Official - Prefix:MR
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:N
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:210-924-6471
Mailing Address - Street 1:7333 BARLITE BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78224-1322
Mailing Address - Country:US
Mailing Address - Phone:210-924-6471
Mailing Address - Fax:210-924-6473
Practice Address - Street 1:7333 BARLITE BLVD STE 150
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224-1322
Practice Address - Country:US
Practice Address - Phone:210-924-6471
Practice Address - Fax:210-924-6473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11432183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1084014Medicaid
TX4504002OtherNABP#
TX130880OtherTEXAS VENDOR DRUG PROG.