Provider Demographics
NPI:1558464479
Name:QUALITY PHARMACY
Entity Type:Organization
Organization Name:QUALITY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:361-594-2262
Mailing Address - Street 1:PO BOX 697
Mailing Address - Street 2:
Mailing Address - City:SHINER
Mailing Address - State:TX
Mailing Address - Zip Code:77984-0697
Mailing Address - Country:US
Mailing Address - Phone:361-594-2262
Mailing Address - Fax:361-594-4393
Practice Address - Street 1:408 N AVENUE B
Practice Address - Street 2:
Practice Address - City:SHINER
Practice Address - State:TX
Practice Address - Zip Code:77984-7126
Practice Address - Country:US
Practice Address - Phone:361-594-2262
Practice Address - Fax:361-594-3629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX019433336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130389Medicaid
TX130389Medicaid