Provider Demographics
NPI:1235847237
Name:NEW CULEBRA PHARMACY LLC
Entity Type:Organization
Organization Name:NEW CULEBRA PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:NIKUL
Authorized Official - Middle Name:
Authorized Official - Last Name:DHADUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-757-3940
Mailing Address - Street 1:23339 ENCHANTED FALL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78260-4339
Mailing Address - Country:US
Mailing Address - Phone:973-978-5118
Mailing Address - Fax:
Practice Address - Street 1:9793 CULEBRA RD STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-3750
Practice Address - Country:US
Practice Address - Phone:210-757-3940
Practice Address - Fax:210-610-5225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy