1841263951 NPI number — PRO MED PHARMACIES INC

Table of content: (NPI 1841263951)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841263951 NPI number — PRO MED PHARMACIES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRO MED PHARMACIES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841263951
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3615 SW 45TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMARILLO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79109-5662
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-379-7126
Provider Business Mailing Address Fax Number:
806-372-3984

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 N TAYLOR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMARILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79107-5279
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-376-8245
Provider Business Practice Location Address Fax Number:
806-379-7514
Provider Enumeration Date:
02/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHRYSLER
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT CEO
Authorized Official Telephone Number:
806-379-7126

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  0083114 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: 13048 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 13048 . This is a "TEXAS PHARMACY LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 5403049900 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 83114 . This is a "MEDICAL DEVICE DISTRIBUTI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: NRP57 . This is a "NON RESIDENT" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 9000358300 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 108484001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4578235 . This is a "NCPDP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: W0070866 . This is a "CONTROLLED SUBSTANCE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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