Provider Demographics
NPI:1871783324
Name:BUENA VISTA PHARMACY, INC
Entity type:Organization
Organization Name:BUENA VISTA PHARMACY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:D
Authorized Official - Last Name:IBANEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:210-674-1900
Mailing Address - Street 1:8920 US HIGHWAY 87 E STE 4A
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78263-2238
Mailing Address - Country:US
Mailing Address - Phone:210-648-9001
Mailing Address - Fax:210-649-9004
Practice Address - Street 1:8920 US HIGHWAY 87 E STE 4A
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78263-2238
Practice Address - Country:US
Practice Address - Phone:210-648-9001
Practice Address - Fax:210-649-9004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX256583336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy