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Organization
SUPER DRUG MART, INC.
Active
Organization
SUPER DRUG MART, INC.
Active
Other names
Super Drug Mart
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAYMOND D IBANEZ SR. PHARM.D. (OWNER/PHARMACIST)
(830) 709-0360
Entity
Organization
Contact information
Practice address
5555 FREDERICKSBURG RD, SUITE 105, SAN ANTONIO, TX 78229-3500
(210) 495-7516
(210) 340-6998
Mailing address
19010 PREIST BLVD, SUITE 101, LYTLE, TX 78052-3486
(830) 709-0360
(830) 709-0363
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
20307
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
144974
—
TX
01
—
20307
STATE BOARD OF PHARMACY
TX
Enumeration date
06/12/2015
Last updated
06/12/2015
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