Provider Demographics
NPI:1568496578
Name:FARMACIA ASSOCIATES OF SAN ANTONIO INC.
Entity Type:Organization
Organization Name:FARMACIA ASSOCIATES OF SAN ANTONIO INC.
Other - Org Name:SOUTH SAN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORP. SEC-TREAS
Authorized Official - Prefix:MR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEAL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:210-922-1816
Mailing Address - Street 1:919 SW MILITARY DR
Mailing Address - Street 2:#105
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-1579
Mailing Address - Country:US
Mailing Address - Phone:210-922-1816
Mailing Address - Fax:210-922-9732
Practice Address - Street 1:919 SW MILITARY DR
Practice Address - Street 2:#105
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78221-1579
Practice Address - Country:US
Practice Address - Phone:210-922-1816
Practice Address - Fax:210-922-9732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101653336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142417Medicaid
TX011865501Medicaid
TX142417Medicaid