Provider Demographics
NPI:1689689218
Name:U B A PHARMACY LLC
Entity Type:Organization
Organization Name:U B A PHARMACY LLC
Other - Org Name:UBA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHIBE
Authorized Official - Middle Name:
Authorized Official - Last Name:UBABUIKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-646-8804
Mailing Address - Street 1:2003 ROGERS RD STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-4834
Mailing Address - Country:US
Mailing Address - Phone:210-680-0882
Mailing Address - Fax:210-680-0884
Practice Address - Street 1:2003 ROGERS RD STE 102
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4834
Practice Address - Country:US
Practice Address - Phone:210-680-0882
Practice Address - Fax:210-680-0884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX233473336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2097595OtherPK
TX145438Medicaid
2097595OtherPK