Organization
SLG PHARMACY LLC
Active
Other names
Laurel Heights Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
ANNAPURNA MADDALI (OFFICER)
(917) 769-8014
Entity
Organization
Contact information
Practice address
2602 N MAIN AVE, SAN ANTONIO, TX 78212-2919
(210) 736-3161
Mailing address
2602 N MAIN AVE, SAN ANTONIO, TX 78212-2919
(210) 736-3161
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
1935
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5905356
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
03/15/2012
Last updated
03/21/2012
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