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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