Provider Demographics
NPI:1891279915
Name:MEDFUSION PHARMACY
Entity Type:Organization
Organization Name:MEDFUSION PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:GRAY
Authorized Official - Last Name:HARDAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-445-9079
Mailing Address - Street 1:17115 SAN PEDRO AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-2685
Mailing Address - Country:US
Mailing Address - Phone:210-445-9079
Mailing Address - Fax:888-217-1216
Practice Address - Street 1:8812 BROADWAY ST STE A
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-6318
Practice Address - Country:US
Practice Address - Phone:210-624-7648
Practice Address - Fax:888-217-1216
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDFUSION, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy