Organization
MICHAEL W. JACKSON, A SOLE PROPRIETOR
Active
Other names
SAN AUGUSTINE DRUG COMPANY
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL W JACKSON (OWNER)
(936) 275-3401
Entity
Organization
Contact information
Practice address
104 E COLUMBIA ST, SAN AUGUSTINE, TX 75972-1902
(936) 275-3401
(936) 275-3450
Mailing address
104 E COLUMBIA ST, SAN AUGUSTINE, TX 75972-1902
(936) 275-3401
(936) 275-3450
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
13848
TX
Other
Enumeration date
08/30/2006
Last updated
06/12/2015
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