NPIMap

Organization Active NPI

Marios Pharmacy Inc

  • Community/Retail Pharmacy
  • San Antonio, TX
National Provider Identifier
1376564310
Registry record updated Sep 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
24112 Issued in TX
Legal business name
MARIOS PHARMACY INC
Practice address
2515 Broadway St
San Antonio, TX 78215-1037
Phone
(210) 354-0101
Fax
(210) 354-0404
NPI assigned
Jul 23, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jessica Ruiz, RNNPI 1003572207
Title
Controller
Phone
(210) 913-2244

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 24112 TX Primary
Compounding Pharmacy 3336C0004X

Addresses

Primary practice location

2515 Broadway St
San Antonio, TX 78215-1037

Mailing address

2501 W William Cannon Dr
Ste. 203
Austin, TX 78745-5281
Phone (512) 707-2300

Other identifiers 2

IdentifierTypeStateIssuer
145542MedicaidTX
2097195OtherPK

Other names 1

  • Stonegate Pharmacy on Broadway Doing business as

National Provider Directory

National Provider Directory

Locations

2515 Broadway St
San Antonio, TX 78215
Phone (210) 354-0101

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1504656000000",
    "number": "1376564310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2501 W WILLIAM CANNON DR",
            "address_2": "STE. 203",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787455281",
            "telephone_number": "512-707-2300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2515 BROADWAY ST",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782151037",
            "telephone_number": "210-354-0101",
            "fax_number": "210-354-0404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIOS PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-23",
        "last_updated": "2017-09-06",
        "status": "A",
        "authorized_official_last_name": "RUIZ",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "210-913-2244",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "24112",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "145542",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2097195",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stonegate Pharmacy on Broadway",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.