1649846494 NPI number — CRESTMARK PHARMACY SERVICES OF TEXAS LLC

Table of content: (NPI 1649846494)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649846494 NPI number — CRESTMARK PHARMACY SERVICES OF TEXAS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRESTMARK PHARMACY SERVICES OF TEXAS 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:
1649846494
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
433 N MACARTHUR AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PANAMA CITY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32401-3767
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-381-1433
Provider Business Mailing Address Fax Number:
850-872-1321

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 ELLA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOMBALL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77375-5094
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
346-273-0002
Provider Business Practice Location Address Fax Number:
866-393-1507
Provider Enumeration Date:
06/02/2021

Additional Information

Authorized Official

Authorized Official Last Name:
MATHES
Authorized Official First Name:
LEIGH
Authorized Official Middle Name:
ANNE
Authorized Official Title or Position:
DIRECTOR OF OPERATIONS
Authorized Official Telephone Number:
850-381-1433

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com