Provider Demographics
NPI:1609860725
Name:JOHN M. MOHRMANN, INC.
Entity Type:Organization
Organization Name:JOHN M. MOHRMANN, INC.
Other - Org Name:WHITE CROSS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MATTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAWICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-224-1371
Mailing Address - Street 1:415 CAMDEN ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215-1923
Mailing Address - Country:US
Mailing Address - Phone:210-224-1371
Mailing Address - Fax:210-223-5272
Practice Address - Street 1:1303 MCCULLOUGH AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-5609
Practice Address - Country:US
Practice Address - Phone:210-227-7207
Practice Address - Fax:210-223-5272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10309333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX508743OtherBLUECROSSBLUESHIELD
TX=========OtherPRIVATE INSURANCES
TX0758300001Medicare ID - Type Unspecified