Provider Demographics
NPI:1467442699
Name:BLANCO COMMUNITY PHARMACY & HEALTH CENTER LLC
Entity Type:Organization
Organization Name:BLANCO COMMUNITY PHARMACY & HEALTH CENTER LLC
Other - Org Name:STRICKLAND DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SIOBHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ATCHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-833-4815
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:BLANCO
Mailing Address - State:TX
Mailing Address - Zip Code:78606-0369
Mailing Address - Country:US
Mailing Address - Phone:830-833-4815
Mailing Address - Fax:830-833-5585
Practice Address - Street 1:316 PECAN ST
Practice Address - Street 2:
Practice Address - City:BLANCO
Practice Address - State:TX
Practice Address - Zip Code:78606
Practice Address - Country:US
Practice Address - Phone:830-833-4815
Practice Address - Fax:830-833-5585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX280863336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146637Medicaid
2135949OtherPK
6845710001Medicare NSC