Provider Demographics
NPI:1801228143
Name:PHARMACY CARE USA OF SAN MARCOS, LLC
Entity Type:Organization
Organization Name:PHARMACY CARE USA OF SAN MARCOS, LLC
Other - Org Name:PHARMACY CARE USA OF SAN MARCOS, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KENT
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-663-4111
Mailing Address - Street 1:PO BOX 431
Mailing Address - Street 2:
Mailing Address - City:HYDRO
Mailing Address - State:OK
Mailing Address - Zip Code:73048-0431
Mailing Address - Country:US
Mailing Address - Phone:405-663-4111
Mailing Address - Fax:405-663-4114
Practice Address - Street 1:2260 IH 35 S STE 201
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-6172
Practice Address - Country:US
Practice Address - Phone:512-392-5790
Practice Address - Fax:512-392-5792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX271613336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2141414OtherPK