1699290577 NPI number — DLB PHARMACY LLC

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 1699290577 NPI number — DLB PHARMACY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DLB PHARMACY LLC
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:
1699290577
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1801 N HAMPTON RD STE 340
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DESOTO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75115-8317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-984-5230
Provider Business Mailing Address Fax Number:
214-206-0160

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1801 N HAMPTON
Provider Second Line Business Practice Location Address:
SUITE 340
Provider Business Practice Location Address City Name:
DESOTO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-984-5230
Provider Business Practice Location Address Fax Number:
214-206-0160
Provider Enumeration Date:
08/11/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MOTLOW
Authorized Official First Name:
VERNON
Authorized Official Middle Name:
ALLEN
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
901-921-5445

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  31513 , 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)