Provider Demographics
NPI:1386628311
Name:FRONTIER PHARMACY INC.
Entity Type:Organization
Organization Name:FRONTIER PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUCKY
Authorized Official - Middle Name:STEVE
Authorized Official - Last Name:OTT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:830-896-2466
Mailing Address - Street 1:1001 WATER ST STE F-100
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-3573
Mailing Address - Country:US
Mailing Address - Phone:830-896-2466
Mailing Address - Fax:830-896-7689
Practice Address - Street 1:1001 WATER ST STE F-100
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-3573
Practice Address - Country:US
Practice Address - Phone:830-896-2466
Practice Address - Fax:830-896-7689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-02
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX03598333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy