1588696835 NPI number — PHARMACY PLUS, INC.

Table of content: (NPI 1588696835)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588696835 NPI number — PHARMACY PLUS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHARMACY PLUS, 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:
Provider Other Organization Name Type Code:
6
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:
1588696835
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2901 CORPORATE CIR
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
FLOWER MOUND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75028-5625
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-739-2526
Provider Business Mailing Address Fax Number:
254-739-2528

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
635 N ROBINSON DR
Provider Second Line Business Practice Location Address:
SUITE 16
Provider Business Practice Location Address City Name:
ROBINSON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76706-5330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-662-4444
Provider Business Practice Location Address Fax Number:
254-662-0805
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NEALE
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
MANNING
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
469-635-2849

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  16892 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 16892 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0004X , with the licence number: 16892 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 144453 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4579249 . This is a "NCPDP #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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