Provider Demographics
NPI:1043623226
Name:IRVING PHARMACY LLC
Entity Type:Organization
Organization Name:IRVING PHARMACY LLC
Other - Org Name:IRVING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, AO, PHCY MANAGER, PIC
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SAADEH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:972-313-0585
Mailing Address - Street 1:2000 ESTERS RD STE 202
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-8019
Mailing Address - Country:US
Mailing Address - Phone:972-313-0585
Mailing Address - Fax:972-313-0517
Practice Address - Street 1:2000 ESTERS RD STE 202
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-8019
Practice Address - Country:US
Practice Address - Phone:972-313-0585
Practice Address - Fax:972-313-0517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-05
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX292783336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2145908OtherPK
TX148007Medicaid