Organization
MEDICINE MAN, L.P.
Active
Other names
Santa Fe Medicine Man, L.P.
Organization subpart
No
Provider details
NPI number
Authorized official
ERNEST H. ZOST RPH (PRESIDENT & CEO)
(972) 860-0202
Entity
Organization
Contact information
Practice address
13250 HIGHWAY 6, SANTA FE, TX 77510-7682
(409) 925-3522
(409) 925-9958
Mailing address
16250 DALLAS PKWY, SUITE 100, DALLAS, TX 75248-2626
(972) 860-0200
(972) 860-0298
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
20997
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
145138
—
TX
Enumeration date
04/24/2006
Last updated
08/22/2020
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