Organization
JSA HEALTHCARE SERVICES LLC
Active
Other names
EVOLVE SPECIALTY PHARMACY & WELLNESS
Organization subpart
No
Provider details
NPI number
Authorized official
LUBNA ALGHOUL (MANAGER)
(561) 305-3648
Entity
Organization
Contact information
Practice address
19239 STONE OAK PKWY STE 103, SAN ANTONIO, TX 78258-3471
(210) 314-6464
(210) 314-6465
Mailing address
3035 FALL CREST DR, SAN ANTONIO, TX 78247-3235
(561) 305-3648
(210) 314-6465
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
—
—
333600000X
Pharmacy
Primary
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34147
TEXAS STATE BOARD OF PHARMACY
TX
Enumeration date
02/11/2022
Last updated
03/15/2022
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