Organization
BUENA VISTA PHARMACY INC
Active
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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