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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