Provider Demographics
NPI:1083637987
Name:DOUGHERTYS PHARMACY INC
Entity Type:Organization
Organization Name:DOUGHERTYS PHARMACY INC
Other - Org Name:DOUGHERTYS HOME CARE PHCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEA
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-250-0945
Mailing Address - Street 1:PO BOX 678050
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-8050
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:515 PRESTON ROYAL VILLAGE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230
Practice Address - Country:US
Practice Address - Phone:214-363-4310
Practice Address - Fax:214-363-6570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16496333600000X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4594758OtherOTHER ID NUMBER-COMMERCIAL NUMBER
TX320153Medicaid
4594758OtherOTHER ID NUMBER-COMMERCIAL NUMBER