Provider Demographics
NPI:1871074740
Name:BABCOCK PHARMACY LLC
Entity type:Organization
Organization Name:BABCOCK PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DUDLEY
Authorized Official - Middle Name:ILES
Authorized Official - Last Name:KLATT
Authorized Official - Suffix:II
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:210-298-9000
Mailing Address - Street 1:2425 BABCOCK RD STE 108A
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4899
Mailing Address - Country:US
Mailing Address - Phone:210-298-9000
Mailing Address - Fax:210-298-9001
Practice Address - Street 1:2425 BABCOCK RD STE 108A
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4899
Practice Address - Country:US
Practice Address - Phone:210-298-9000
Practice Address - Fax:210-298-9001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-28
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32121333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy