Organization
SUPER ROCKWALL DRUGSTORE,LP
Active
Organization
SUPER ROCKWALL DRUGSTORE,LP
Active
Other names
SUPER DRUG
Organization subpart
No
Provider details
NPI number
Authorized official
MISS MARITES TALAVERA SERNA RPH (PRESIDENT)
(972) 772-0500
Entity
Organization
Contact information
Practice address
3021 RIDGE RD, SUITE 103, ROCKWALL, TX 75032-5806
(972) 772-0500
(972) 772-5512
Mailing address
3021 RIDGE RD, SUITE 103, ROCKWALL, TX 75032-5806
(972) 772-0500
(972) 772-5512
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
22390
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
145240
—
TX
01
—
22390
TEXAS PHARMACY LICENSE
TX
Enumeration date
02/19/2007
Last updated
03/11/2015
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