Organization
JEFFERSON PHARMACY INC
Active
Other names
JEFFERSON PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN KENNEDY (MANAGING MEMBER)
(210) 824-0771
Entity
Organization
Contact information
Practice address
917 MANOR DR, SAN ANTONIO, TX 78228-3227
(210) 734-5133
(210) 735-8815
Mailing address
917 MANOR DR, SAN ANTONIO, TX 78228-3227
(210) 734-5133
(210) 735-8815
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
06118
TX
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
144858
—
TX
01
—
4530487
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
03/01/2007
Last updated
10/26/2010
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