Provider Demographics
NPI:1134540917
Name:3 WILD ONES LLC
Entity type:Organization
Organization Name:3 WILD ONES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MICHAEL LOUIS
Authorized Official - Last Name:BERARD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:504-481-5364
Mailing Address - Street 1:33 SULFUR CYN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247
Mailing Address - Country:US
Mailing Address - Phone:504-481-5364
Mailing Address - Fax:210-819-4516
Practice Address - Street 1:26108 OVERLOOK PKWY
Practice Address - Street 2:BLDG 4
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78260
Practice Address - Country:US
Practice Address - Phone:210-819-4515
Practice Address - Fax:210-819-4516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-23
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty