Provider Demographics
NPI:1639218563
Name:TEXAS STATE UNIVERSITY
Entity Type:Organization
Organization Name:TEXAS STATE UNIVERSITY
Other - Org Name:TEXAS STATE UNIVERSITY STUDENT HEALTH CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:STUDENT HEALTH CENTER DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILIO
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRANCO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:512-245-2161
Mailing Address - Street 1:601 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-4684
Mailing Address - Country:US
Mailing Address - Phone:512-245-3590
Mailing Address - Fax:512-245-3652
Practice Address - Street 1:298 STUDENT CENTER DR.
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666
Practice Address - Country:US
Practice Address - Phone:512-245-3590
Practice Address - Fax:512-245-3652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX060463336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX06046OtherSTATE BOARD
TX4567763OtherNABP