Organization
KIDZ MEDICAL SUPPLY LLC
Active
Organization
KIDZ MEDICAL SUPPLY LLC
Active
Other names
Kidz Medical Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
SUZANNE AFALAVA (VP)
(210) 365-5135
Entity
Organization
Contact information
Practice address
700 S ZARZAMORA ST, STE 302, SAN ANTONIO, TX 78207-5255
(210) 433-9400
(210) 433-9402
Mailing address
700 S ZARZAMORA ST, STE 302, SAN ANTONIO, TX 78207-5255
(210) 433-9400
(210) 433-9402
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
26389
TX
3336M0002X
Mail Order Pharmacy
—
—
3336S0011X
Specialty Pharmacy
26389
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
204861301
—
TX
01
—
4552673
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
04/11/2007
Last updated
11/15/2011
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