Organization
COMMUNITY PHARMACY
Active
Other names
COMMUNITY PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MARTY DANIEL RPH (OWNER/PARTNER)
(325) 949-4577
Entity
Organization
Contact information
Practice address
3520 KNICKERBOCKER RD STE A, SAN ANGELO, TX 76904-7601
(325) 949-4577
(325) 224-0997
Mailing address
3520 KNICKERBOCKER RD STE A, SAN ANGELO, TX 76904-7601
(325) 949-4577
(325) 224-0997
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
13817
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
143638
—
TX
01
—
2099101
PK
—
Enumeration date
08/18/2006
Last updated
02/20/2017
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