Organization
MANAGED CARE PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN T REDIGER (RPH)
(432) 445-4916
Entity
Organization
Contact information
Practice address
721 S. PALM, PECOS, TX 79772
(432) 445-4916
(432) 445-6085
Mailing address
721 S. PALM, PECOS, TX 79772
(432) 445-4916
(432) 445-6085
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
15928
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
350046
—
TX
Enumeration date
02/22/2007
Last updated
03/10/2008
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