Provider Demographics
NPI:1083962963
Name:WPMD LLC
Entity Type:Organization
Organization Name:WPMD LLC
Other - Org Name:PARKWOOD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THAI
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-642-5613
Mailing Address - Street 1:3415 S COOPER ST
Mailing Address - Street 2:STE 106
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-3446
Mailing Address - Country:US
Mailing Address - Phone:817-642-5613
Mailing Address - Fax:682-238-3686
Practice Address - Street 1:3415 S COOPER ST
Practice Address - Street 2:STE 106
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-3446
Practice Address - Country:US
Practice Address - Phone:817-642-5613
Practice Address - Fax:682-238-3686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-27
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
TX281253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2136587OtherPK