Provider Demographics
NPI:1043313174
Name:MCMAHAN PHARMACY SERVICES INC
Entity Type:Organization
Organization Name:MCMAHAN PHARMACY SERVICES INC
Other - Org Name:MCMAHAN PHARMACY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:325-648-2484
Mailing Address - Street 1:PO BOX 389
Mailing Address - Street 2:
Mailing Address - City:GOLDTHWAITE
Mailing Address - State:TX
Mailing Address - Zip Code:76844-0389
Mailing Address - Country:US
Mailing Address - Phone:325-648-2484
Mailing Address - Fax:325-648-3417
Practice Address - Street 1:1503 W FRONT ST
Practice Address - Street 2:
Practice Address - City:GOLDTHWAITE
Practice Address - State:TX
Practice Address - Zip Code:76844-2056
Practice Address - Country:US
Practice Address - Phone:325-648-2484
Practice Address - Fax:325-648-3417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336L0003X, 3336S0011X
TX043973336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2096759OtherPK
TX141499Medicaid
0416990001Medicare NSC