1740507599 NPI number — MD PHARMACUETICALS LLC

Table of content: (NPI 1740507599)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740507599 NPI number — MD PHARMACUETICALS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MD PHARMACUETICALS 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:
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:
1740507599
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
502 S OLD ORCHARD LN
Provider Second Line Business Mailing Address:
SUITE 128
Provider Business Mailing Address City Name:
LEWISVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75067-4370
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-906-0067
Provider Business Mailing Address Fax Number:
972-906-9084

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
204 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ITALY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76651-3517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-483-7667
Provider Business Practice Location Address Fax Number:
972-483-7670
Provider Enumeration Date:
05/03/2010

Additional Information

Authorized Official

Authorized Official Last Name:
DENNIS
Authorized Official First Name:
MARTIN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
972-822-3615

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  26871 , 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: 26871 . This is a "TEXAS STATE BOARD OF PHARMACY" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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