1780980862 NPI number — ZALCON PHARMACY

Table of content: (NPI 1780980862)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780980862 NPI number — ZALCON PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ZALCON PHARMACY
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:
ZALCON GROUP LLC
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:
1780980862
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 TRAILSIDE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANSFIELD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76063-5463
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-939-4559
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9101 LAKEVIEW PKW
Provider Second Line Business Practice Location Address:
STE. 500
Provider Business Practice Location Address City Name:
ROWLETT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75088
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-412-7842
Provider Business Practice Location Address Fax Number:
972-412-9884
Provider Enumeration Date:
02/07/2011

Additional Information

Authorized Official

Authorized Official Last Name:
ONWUMERE
Authorized Official First Name:
PRISCA
Authorized Official Middle Name:
N
Authorized Official Title or Position:
PHARMACIST-IN-CHARGE
Authorized Official Telephone Number:
817-939-4559

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  27332 , 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)





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