Super Drug Mart INC

NPI #1679623482 in Lytle, Texas

Provider Information

NPI Number: 1679623482
Entity Type: Organization
Organization Name: Super Drug Mart INC
Primary Specialty: Pharmacist
Enumeration Date: Jan 12, 2007
Last Updated: May 19, 2015

Practice Location

Address: 19010 PRIEST BLVD
City: Lytle
State: Texas
ZIP Code: 78052
Phone: (830) 709-0360

Authorized Official

Name: MR. RAYMOND D. IBANEZ SR.
Title: OWNER/PHARMACIST
Phone: (210) 884-2543

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pharmacist	183500000X	Primary

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