Buena Vista Pharmacy, Inc.

Primary specialty

PharmacistTaxonomy code 183500000X

License

18224 Issued in TX

Legal business name

BUENA VISTA PHARMACY, INC.

Doing business as

dba Super Drug Mart #4

Practice address

7323 Marbach Rd Ste 105
San Antonio, TX 78227-1905

Phone

(210) 674-1900

Fax

(210) 674-5404

NPI assigned

Mar 15, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Raymond D Ibanez, RPH

Title

President Pharmacist in Charge

Phone

(210) 674-1900

Specialties & licenses 1

Addresses

Other identifiers 5

Other names 1

• dba Super Drug Mart #4 Doing business as

Locations

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

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1385942400000",
    "number": "1649304320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7323 MARBACH RD STE 105",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782271905",
            "telephone_number": "210-674-1900",
            "fax_number": "210-674-5404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7323 MARBACH RD STE 105",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782271905",
            "telephone_number": "210-674-1900",
            "fax_number": "210-674-5404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BUENA VISTA PHARMACY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-15",
        "last_updated": "2013-12-02",
        "status": "A",
        "authorized_official_last_name": "IBANEZ",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT  PHARMACIST IN CHARGE",
        "authorized_official_telephone_number": "210-674-1900",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": "TX",
            "license": "18224",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010729401",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "067296601",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP",
            "identifier": "4567270",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "016578901",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "142614",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "dba Super Drug Mart #4",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Gloria Vanessa Bueno

• Pharmacist in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Pharmacist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2013; 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.