Organization
PROFESSIONAL PAVILION PHARMACY INC
Active
Organization
PROFESSIONAL PAVILION PHARMACY INC
Active
Other names
PROFESSIONAL PAVILION PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERTO MARTIN MD (OWNER)
(210) 271-7575
Entity
Organization
Contact information
Practice address
315 N SAN SABA, STE 110, SAN ANTONIO, TX 78207-3154
(210) 212-7455
(210) 212-6643
Mailing address
315 N SAN SABA, STE 110, SAN ANTONIO, TX 78207-3154
(210) 212-7455
(210) 212-6643
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
17417
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4599950
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
12/26/2006
Last updated
10/19/2012
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