1295237543 NPI number — SOCIETY OF ST. VINCENT DE PAUL CHARITABLE PHARMACY OF NORTH TEXAS, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295237543 NPI number — SOCIETY OF ST. VINCENT DE PAUL CHARITABLE PHARMACY OF NORTH TEXAS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOCIETY OF ST. VINCENT DE PAUL CHARITABLE PHARMACY OF NORTH TEXAS, 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:
ST. VINCENT DE PAUL PHARMACY
Provider Other Organization Name Type Code:
3
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:
1295237543
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4310 GLENWICK LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75205-1035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-868-8944
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5750 PINELAND DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75231-5300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-232-9902
Provider Business Practice Location Address Fax Number:
469-533-0350
Provider Enumeration Date:
03/02/2018

Additional Information

Authorized Official

Authorized Official Last Name:
HERMANN
Authorized Official First Name:
CLARENCE
Authorized Official Middle Name:
HENRY
Authorized Official Title or Position:
PHARMACY MANAGING DIRECTOR
Authorized Official Telephone Number:
214-868-8944

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  31881 , 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: 31881 . This is a "TEXAS STATE BOARD OF PHARMACY" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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