Provider Demographics
NPI:1033340955
Name:U.S. PHARMACY, INC. STORE#2
Entity Type:Organization
Organization Name:U.S. PHARMACY, INC. STORE#2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:O'DONNELL
Authorized Official - Last Name:NEWTON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:817-531-8880
Mailing Address - Street 1:4245 E BERRY ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76105-5002
Mailing Address - Country:US
Mailing Address - Phone:817-531-8880
Mailing Address - Fax:817-531-8886
Practice Address - Street 1:4245 E BERRY ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76105
Practice Address - Country:US
Practice Address - Phone:817-478-9191
Practice Address - Fax:817-572-0740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX265633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy