Provider Demographics
NPI:1497724884
Name:SHINER FAMILY PHARMACY, INC
Entity Type:Organization
Organization Name:SHINER FAMILY PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:E
Authorized Official - Last Name:HILSCHER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:361-594-2394
Mailing Address - Street 1:408 N. AVE B
Mailing Address - Street 2:P.O. BOX 666
Mailing Address - City:SHINER
Mailing Address - State:TX
Mailing Address - Zip Code:77984
Mailing Address - Country:US
Mailing Address - Phone:361-594-2394
Mailing Address - Fax:361-594-3629
Practice Address - Street 1:408 N. AVE B
Practice Address - Street 2:
Practice Address - City:SHINER
Practice Address - State:TX
Practice Address - Zip Code:77984
Practice Address - Country:US
Practice Address - Phone:361-594-2394
Practice Address - Fax:361-594-3629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16094332B00000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144135Medicaid
TX144135Medicaid