Organization
MEDICINE MAN PHARMACY-BRAZORIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE W ROGERS R.PH. (OWNER)
(979) 798-4800
Entity
Organization
Contact information
Practice address
102 E SAN BERNARD ST, A, BRAZORIA, TX 77422-5647
(979) 798-4800
(979) 798-4803
Mailing address
PO BOX 3670, VICTORIA, TX 77903-3670
(979) 798-4800
(979) 798-4803
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
30626
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30626
TEXAS STATE BOARD OF PHARMACY
TX
Enumeration date
02/11/2016
Last updated
05/23/2016
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