Organization
MARIOS PHARMACY INC
Active
Other names
Stonegate Pharmacy on Broadway
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA RUIZ RN (CONTROLLER)
(210) 913-2244
Entity
Organization
Contact information
Practice address
2515 BROADWAY ST, SAN ANTONIO, TX 78215-1037
(210) 354-0101
(210) 354-0404
Mailing address
2501 W WILLIAM CANNON DR, STE. 203, AUSTIN, TX 78745-5281
(512) 707-2300
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
24112
TX
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
145542
—
TX
01
—
2097195
PK
—
Enumeration date
07/23/2006
Last updated
09/06/2017
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