1497878722 NPI number — NORTH TEXAS INFUSION AND SPECIALTY PHARMACY, L.L.C.

Table of content: (NPI 1497878722)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497878722 NPI number — NORTH TEXAS INFUSION AND SPECIALTY PHARMACY, L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH TEXAS INFUSION AND SPECIALTY PHARMACY, L.L.C.
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:
1497878722
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3409 WORTH STREET
Provider Second Line Business Mailing Address:
SUITE 725
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75246
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-276-5616
Provider Business Mailing Address Fax Number:
214-887-0436

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3409 WORTH STREET
Provider Second Line Business Practice Location Address:
SUITE 725
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-276-5616
Provider Business Practice Location Address Fax Number:
214-887-0436
Provider Enumeration Date:
04/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LOWERY
Authorized Official First Name:
LEON
Authorized Official Middle Name:
HERCHEL
Authorized Official Title or Position:
PHARMACIST-IN-CHARGE
Authorized Official Telephone Number:
214-276-5617

Provider Taxonomy Codes

  • Taxonomy code: 3336H0001X , with the licence number:  25670 , 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: 25670 . This is a "STATE LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: R0155996 . This is a "DPS LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 99-1242 . This is a "NON-RESIDENT" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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