Organization
THE MEDICINE SHOPPE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENA FERMAN (THIRD PARTY PLAN COORDINATOR)
(314) 993-6000
Entity
Organization
Contact information
Practice address
1417 E AIRLINE RD, VICTORIA, TX 77901-4111
(361) 573-6385
(361) 573-1617
Mailing address
1417 E AIRLINE RD, VICTORIA, TX 77901-4111
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
17002
TX
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
144412
—
TX
01
—
4533128
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
11/15/2006
Last updated
03/07/2023
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