Organization
EILA CORPORATION
Active
Other names
Pioneer Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY OLIVER RPH (MANAGER/OWNER)
(210) 492-3005
Entity
Organization
Contact information
Practice address
4503 DE ZAVALA RD STE 108, SAN ANTONIO, TX 78249-2060
(210) 492-3005
(210) 492-3007
Mailing address
4503 DE ZAVALA RD STE 108, SAN ANTONIO, TX 78249-2060
(210) 492-3005
(210) 492-3007
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
21462
TX
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
091708003
—
TX
05
—
091708004
—
TX
05
—
091708005
—
TX
05
—
145149
—
TX
05
—
145952
—
TX
01
—
2093424
PK
—
Enumeration date
02/13/2007
Last updated
06/10/2015
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