Organization
EPOCH PHARMACY SOLUTIONS II LLC
Active
Other names
MEDICINE MAN PHARMACY-PORT LAVACA
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE ROGERS (OWNER)
(361) 894-6430
Entity
Organization
Contact information
Practice address
1202 N VIRGINIA ST, PORT LAVACA, TX 77979-2507
(361) 482-0345
(361) 482-0348
Mailing address
PO BOX 3670, VICTORIA, TX 77903-3670
(361) 894-6430
(361) 894-6431
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
27709
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
146465
—
TX
01
—
2132537
PK
—
Enumeration date
11/01/2011
Last updated
02/16/2016
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