Provider Demographics
NPI:1225170509
Name:EILA CORPORATION
Entity Type:Organization
Organization Name:EILA CORPORATION
Other - Org Name:PIONEER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:210-492-3005
Mailing Address - Street 1:4503 DE ZAVALA RD STE 108
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-2060
Mailing Address - Country:US
Mailing Address - Phone:210-492-3005
Mailing Address - Fax:210-492-3007
Practice Address - Street 1:4503 DE ZAVALA RD STE 108
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2060
Practice Address - Country:US
Practice Address - Phone:210-492-3005
Practice Address - Fax:210-492-3007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX214623336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145149Medicaid
TX091708005Medicaid
TX091708003Medicaid
TX091708004Medicaid
2093424OtherPK
TX145952Medicaid