Organization
MEDICAL CENTER PHARMACY, LTD.CO
Active
Other names
MEDICAL CENTER PHARMACY-STONE OAK
Organization subpart
No
Provider details
NPI number
Authorized official
LUIS VALDIVIESO III PHARM.D. (PHARMACIST-IN-CHARGE)
(210) 833-1935
Entity
Organization
Contact information
Practice address
540 OAK CENTRE DRIVE, SUITE 153, SAN ANTONIO, TX 78258-3937
(210) 332-9862
(210) 332-9585
Mailing address
540 OAK CENTRE DRIVE, SUITE 153, SAN ANTONIO, TX 78258-3937
(210) 332-9862
(210) 332-9585
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
29710
TX
3336C0004X
Compounding Pharmacy
Primary
29710
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2151574
PK
—
Enumeration date
05/07/2015
Last updated
03/02/2016
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