| NPI | 1861870123 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUIS VALDIVIESO Pharmacist In Charge 210-833-1935 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0004X Pharmacy Compounding Pharmacy (Licence: TX 29710) |
| Additional Taxonomies | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: TX 29710) |
| Enumeration Date | 2015-05-07 |
| Last Update Date | 2016-03-02 |