| NPI | 1649304320 |
|---|---|
| Doing Business As | DBA SUPER DRUG MART #4 |
| Entity Type | Organization |
| Authorized Contact | RAYMOND D IBANEZ President Pharmacist In Charge 210-674-1900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 18224) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2013-12-02 |