Provider Demographics
NPI:1760869101
Name:ZIKAM NEIGHBORHOOD PHARMACY LLC
Entity Type:Organization
Organization Name:ZIKAM NEIGHBORHOOD PHARMACY LLC
Other - Org Name:ZIKAM NEIGHBORHOOD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER,PIC,AO
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:OGUAMANAM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:210-503-5063
Mailing Address - Street 1:2527 VILLA BORGHESE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259
Mailing Address - Country:US
Mailing Address - Phone:210-503-5063
Mailing Address - Fax:210-973-5494
Practice Address - Street 1:21920 BULVERDE RD # 102103
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78259-2181
Practice Address - Country:US
Practice Address - Phone:210-503-5063
Practice Address - Fax:210-973-5494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-06
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BN1400X, 333600000X, 3336C0004X
TX299723336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2152335OtherPK
TX147106Medicaid