Provider Demographics
NPI:1932636701
Name:TRAVIS COUNTY JAIL SYSTEM PHARMACY
Entity Type:Organization
Organization Name:TRAVIS COUNTY JAIL SYSTEM PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:CONTRERAS
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:512-854-5364
Mailing Address - Street 1:3614 BILL PRICE RD
Mailing Address - Street 2:
Mailing Address - City:DEL VALLE
Mailing Address - State:TX
Mailing Address - Zip Code:78617-3630
Mailing Address - Country:US
Mailing Address - Phone:512-854-5364
Mailing Address - Fax:512-854-4198
Practice Address - Street 1:3614 BILL PRICE RD
Practice Address - Street 2:
Practice Address - City:DEL VALLE
Practice Address - State:TX
Practice Address - Zip Code:78617-3630
Practice Address - Country:US
Practice Address - Phone:512-854-5364
Practice Address - Fax:512-854-4198
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRAVIS COUNTY SHERIFF'S OFFICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15315251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health