Organization
BUENA VISTA PHARMACY INC
Active
Other names
SUPER DRUG MART TELEPHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
RAYMOND IBANEZ (PHARMACIST IN CHARGE/OWNER)
(210) 674-1900
Entity
Organization
Contact information
Practice address
146 LAUREL VISTA DR, PIPE CREEK, TX 78063-6389
(830) 751-2700
(830) 751-2724
Mailing address
7323 MARBACH RD STE 105, SAN ANTONIO, TX 78227-1905
(210) 674-1900
(210) 674-5404
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
10582
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016578901
—
TX
01
—
2140489
PK
—
Enumeration date
05/29/2013
Last updated
05/29/2013
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