Provider Demographics
NPI:1114003266
Name:FAMILY FIRST PHARMACY LP
Entity Type:Organization
Organization Name:FAMILY FIRST PHARMACY LP
Other - Org Name:FAMILY FIRST PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-561-2822
Mailing Address - Street 1:16623 OLD JACKSONVILLE HWY
Mailing Address - Street 2:STE A
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703
Mailing Address - Country:US
Mailing Address - Phone:903-561-2822
Mailing Address - Fax:903-561-3292
Practice Address - Street 1:16623 OLD JACKSONVILLE HWY
Practice Address - Street 2:STE A
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703
Practice Address - Country:US
Practice Address - Phone:903-561-2822
Practice Address - Fax:903-561-3292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
TX252133336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145719Medicaid
2099583OtherPK
5818850001Medicare NSC