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

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 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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