Organization
MEDI-DRIVE PHARMACY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA KLAIRE BAZALDUA PHARM.D. (PIC)
(806) 655-1024
Entity
Organization
Contact information
Practice address
507 23RD ST, CANYON, TX 79015-4043
(806) 655-1024
(806) 655-9762
Mailing address
507 23RD ST, CANYON, TX 79015-4043
(806) 655-1024
(806) 655-9762
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
31118
TX
3336C0003X
Community/Retail Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2162163
PK
—
Enumeration date
01/04/2008
Last updated
10/31/2025
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