Provider Demographics
NPI:1336243054
Name:FFACTS PHARMACY
Entity Type:Organization
Organization Name:FFACTS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRES./CHIEF REVENUE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MOTE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:210-358-2895
Mailing Address - Street 1:903 W MARTIN ST
Mailing Address - Street 2:C-202
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207
Mailing Address - Country:US
Mailing Address - Phone:210-358-9660
Mailing Address - Fax:210-358-9634
Practice Address - Street 1:527 N LEONA ST
Practice Address - Street 2:C-202
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-3110
Practice Address - Country:US
Practice Address - Phone:210-358-9660
Practice Address - Fax:210-358-9634
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-12
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX232673336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX250478Medicaid
4536097OtherNCPDP# (NABP#)
1009420001Medicare ID - Type Unspecified