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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