Provider Demographics
NPI:1003173097
Name:PSM MSM 100 LLC
Entity Type:Organization
Organization Name:PSM MSM 100 LLC
Other - Org Name:NEIGHBORHOOD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAJDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:PARMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:551-580-8459
Mailing Address - Street 1:801 N MAIN STREET SUITE F
Mailing Address - Street 2:
Mailing Address - City:ANDREWS
Mailing Address - State:TX
Mailing Address - Zip Code:79714
Mailing Address - Country:US
Mailing Address - Phone:551-580-8459
Mailing Address - Fax:432-523-7003
Practice Address - Street 1:801 N MAIN STREET SUITE F
Practice Address - Street 2:
Practice Address - City:ANDREWS
Practice Address - State:TX
Practice Address - Zip Code:79714
Practice Address - Country:US
Practice Address - Phone:432-523-7000
Practice Address - Fax:432-523-7003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-16
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX279943336C0003X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146580Medicaid
2134735OtherPK