Provider Demographics
NPI:1285852111
Name:HIGH PERFORMANCE PHARMACY LLC
Entity Type:Organization
Organization Name:HIGH PERFORMANCE PHARMACY LLC
Other - Org Name:HIGH PERFORMANCE PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PIC
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-691-4779
Mailing Address - Street 1:21 SPURS LN
Mailing Address - Street 2:SL 120
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1669
Mailing Address - Country:US
Mailing Address - Phone:888-757-8967
Mailing Address - Fax:888-751-8969
Practice Address - Street 1:21 SPURS LN
Practice Address - Street 2:SL 120
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1669
Practice Address - Country:US
Practice Address - Phone:210-691-4779
Practice Address - Fax:210-691-4778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX283003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2100101OtherPK