Provider Demographics
NPI:1346480720
Name:CASTLE HILLS PHARMACY LLC
Entity Type:Organization
Organization Name:CASTLE HILLS PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:361-575-6328
Mailing Address - Street 1:3412 SAM HOUSTON DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-2238
Mailing Address - Country:US
Mailing Address - Phone:361-575-6328
Mailing Address - Fax:
Practice Address - Street 1:3412 SAM HOUSTON DR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-2238
Practice Address - Country:US
Practice Address - Phone:361-575-6328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-25
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
6322800001Medicare NSC