Organization
DICOT RX 1 LLC
Active
Organization
DICOT RX 1 LLC
Active
Other names
Boerne Drug Company
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY RICHARD (PIC/OWNER)
(337) 288-7687
Entity
Organization
Contact information
Practice address
725 N MAIN ST STE 2, BOERNE, TX 78006-1623
(830) 331-8183
(830) 428-2581
Mailing address
725 N MAIN ST STE 2, BOERNE, TX 78006-1623
(830) 331-8183
(830) 428-2581
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
30140
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2153834
PK
—
Enumeration date
08/14/2015
Last updated
05/09/2016
Update your record
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