Organization
PORT AVENUE DRUGS INC
Active
Other names
PORT AVENUE DRUG STORE
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE SANCHEZ (PRESIDENT)
(361) 883-8551
Entity
Organization
Contact information
Practice address
913 S PORT AVE, CORPUS CHRISTI, TX 78405-2301
(361) 883-8551
(561) 883-5292
Mailing address
913 S PORT AVE, CORPUS CHRISTI, TX 78405-2301
(361) 883-8551
(561) 883-5292
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
24047
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110492
—
TX
01
—
4516691
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
07/30/2006
Last updated
02/16/2010
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