Organization
LA HACIENDA PHARMACY INC
Active
Organization
LA HACIENDA PHARMACY INC
Active
Other names
LA HACIENDA PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
ADOLFO MONTEMAYOR RPH (OWNER PRESIDENT)
(361) 279-3869
Entity
Organization
Contact information
Practice address
213 S DR E E DUNLAP ST, SAN DIEGO, TX 78384-2801
(361) 279-3869
(361) 279-3182
Mailing address
213 S DR EEDUNLAP ST, SAN DIEGO, TX 78384-2801
(361) 279-3869
(361) 279-3182
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2869
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
370011
—
TX
01
—
4531201
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
02/21/2007
Last updated
04/19/2012
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