Organization
ST MARIE CLINIC PA PHARMACY
Active
Organization
ST MARIE CLINIC PA PHARMACY
Active
Other names
St Marie Clinic PA Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
EDUARDO CARRILLO (PRESIDENT)
(956) 585-7401
Entity
Organization
Contact information
Practice address
10900 N 103RD ST, MISSION, TX 78573-0979
(956) 432-0194
(956) 432-0196
Mailing address
10900 N 103RD ST, MISSION, TX 78573-0979
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
26174
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4549486
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
09/08/2008
Last updated
02/11/2009
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