Jerry'S Pharmacy, LTD
Organization Active NPI Pharmacy · Ingleside, TX
NPI 1225199292 · NPPES record last updated Feb 16, 2010
Key facts
- NPI
- 1225199292
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- License
- 25909 (TX)
- Legal business name
- JERRY'S PHARMACY, LTD
- Practice address
- 2793 Main St
Ingleside, TX 78362-5901 - Phone
- (361) 776-2577
- Fax
- (361) 776-0967
- NPI assigned
- Dec 13, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Jerry Smolik, RPH
- Title
- Pharmacist, Owner
- Phone
- (361) 776-2577
National Provider Directory
Locations
2793 Main St
Ingleside, TX 78362
Phone (361) 776-2577
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist |
183500000X | 23292 | TX | |
| Pharmacy | 333600000X | 25909 | TX | Yes |
Addresses
Primary practice location
2793 Main St
Ingleside, TX 78362-5901
Mailing address
2793 Main St
Ingleside, TX 78362-5901
Phone (361) 776-2577
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 145436 | Medicaid | TX | |
| 166649701 | Medicaid | TX | |
| 4536807 | Other | NCPDP |
Other providers in Ingleside, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 16, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.