Organization
FAM PHARM LLC
Active
Other names
ALAMO SPECIALTY PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MANOHAR MIRYALA (OWNER/OFFICER)
(210) 614-8615
Entity
Organization
Contact information
Practice address
5107 MEDICAL DR, SAN ANTONIO, TX 78229
(210) 614-8615
(210) 692-1191
Mailing address
5107 MEDICAL DR, SAN ANTONIO, TX 78229
(210) 614-8615
(210) 692-1191
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
150147
—
TX
05
—
15047
—
TX
Enumeration date
08/14/2019
Last updated
04/01/2022
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