Provider Demographics
NPI:1023423738
Name:ALAMO CITY PHARMACY LLC
Entity type:Organization
Organization Name:ALAMO CITY PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:F
Authorized Official - Last Name:GARZA-GONGORA
Authorized Official - Suffix:II
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:210-478-0345
Mailing Address - Street 1:3338 OAKWELL COURT, STE:106
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218
Mailing Address - Country:US
Mailing Address - Phone:210-268-0153
Mailing Address - Fax:210-268-0162
Practice Address - Street 1:3338 OAKWELL CT STE 106
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78218-3087
Practice Address - Country:US
Practice Address - Phone:210-268-0153
Practice Address - Fax:210-268-0162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29302333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy