Contract Details
Ancillary Care Services
Facility name
Cantu's Pharmacy
Provider ID
P000004087
NPI
1235341876
Tax ID
741669360
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
504 South Closner Boulevard
Edinburg, TX 78539
United States
County
Hidalgo
Phone
9563836506 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address