Provider Demographics
NPI:1821774910
Name:IMPACT INFUSION CARE, LLC.
Entity Type:Organization
Organization Name:IMPACT INFUSION CARE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:KOENNING
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, PHARMD
Authorized Official - Phone:806-577-3370
Mailing Address - Street 1:9000 TESORO DR STE 600
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-6130
Mailing Address - Country:US
Mailing Address - Phone:210-646-4888
Mailing Address - Fax:726-800-4974
Practice Address - Street 1:9000 TESORO DR STE 600
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-6130
Practice Address - Country:US
Practice Address - Phone:210-646-4888
Practice Address - Fax:726-800-4974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-23
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No251F00000XAgenciesHome Infusion
No251G00000XAgenciesHospice Care, Community Based
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy