Provider Demographics
NPI:1316204217
Name:DAVILA CD PHARMACY LLC
Entity Type:Organization
Organization Name:DAVILA CD PHARMACY LLC
Other - Org Name:DAVILA CD PHARMACY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-226-5293
Mailing Address - Street 1:1423 GUADALUPE ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-5527
Mailing Address - Country:US
Mailing Address - Phone:210-242-4010
Mailing Address - Fax:
Practice Address - Street 1:1423 GUADALUPE ST STE 105
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-5568
Practice Address - Country:US
Practice Address - Phone:210-242-4010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-16
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5905748OtherNCPDP PROVIDER IDENTIFICATION NUMBER