Provider Demographics
NPI:1184034548
Name:ALTA PHARMACEUTICAL CARE INC
Entity Type:Organization
Organization Name:ALTA PHARMACEUTICAL CARE INC
Other - Org Name:ALTA CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARM.D.
Authorized Official - Prefix:
Authorized Official - First Name:SAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTAAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-330-5700
Mailing Address - Street 1:PO BOX 300
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-8135
Mailing Address - Country:US
Mailing Address - Phone:972-603-8522
Mailing Address - Fax:
Practice Address - Street 1:3434 W ILLINOIS AVE STE 7
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-8709
Practice Address - Country:US
Practice Address - Phone:214-330-5700
Practice Address - Fax:214-330-5711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-06
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX292413336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146931OtherPK
TX148011Medicaid