Provider Demographics
NPI:1366127748
Name:PACSOUTH DISTRIBUTION DELAWARE LLC
Entity type:Organization
Organization Name:PACSOUTH DISTRIBUTION DELAWARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN-DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-887-7503
Mailing Address - Street 1:4310 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-3033
Mailing Address - Country:US
Mailing Address - Phone:210-541-7814
Mailing Address - Fax:
Practice Address - Street 1:4310 WEST AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-3033
Practice Address - Country:US
Practice Address - Phone:210-541-7814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
No333600000XSuppliersPharmacy