Provider Demographics
NPI:1467008524
Name:FAM PHARM LLC
Entity Type:Organization
Organization Name:FAM PHARM LLC
Other - Org Name:ALAMO SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MANOHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRYALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-614-8615
Mailing Address - Street 1:5107 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229
Mailing Address - Country:US
Mailing Address - Phone:210-614-8615
Mailing Address - Fax:210-692-1191
Practice Address - Street 1:5107 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-614-8615
Practice Address - Fax:210-692-1191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-14
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150147Medicaid
TX15047Medicaid