Provider Demographics
NPI:1710021019
Name:IRIS ANNA INC
Entity Type:Organization
Organization Name:IRIS ANNA INC
Other - Org Name:PATT'S DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:V PRES
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOHRMANN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:830-672-2317
Mailing Address - Street 1:5320 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-5714
Mailing Address - Country:US
Mailing Address - Phone:210-826-0616
Mailing Address - Fax:210-930-3784
Practice Address - Street 1:5320 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-5714
Practice Address - Country:US
Practice Address - Phone:210-826-0616
Practice Address - Fax:210-930-3784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142811Medicaid