Provider Demographics
NPI:1083986780
Name:GUADALUPE COUNTY HOSPITAL BOARD
Entity Type:Organization
Organization Name:GUADALUPE COUNTY HOSPITAL BOARD
Other - Org Name:GUADALUPE REGIONAL MEDICAL CENTER PAP PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST PAP
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:RIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-401-7603
Mailing Address - Street 1:1331 E COURT ST
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-5138
Mailing Address - Country:US
Mailing Address - Phone:830-401-7603
Mailing Address - Fax:830-401-7602
Practice Address - Street 1:1331 E COURT ST
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5138
Practice Address - Country:US
Practice Address - Phone:830-401-7603
Practice Address - Fax:830-401-7602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-27
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66143336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5905015OtherNCPDP PROVIDER IDENTIFICATION NUMBER