Provider Demographics
NPI:1184862146
Name:AYDIL HEALTHCARE, PLLC
Entity Type:Organization
Organization Name:AYDIL HEALTHCARE, PLLC
Other - Org Name:MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:VIMAL
Authorized Official - Middle Name:LAKHU
Authorized Official - Last Name:BHAKTA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:972-734-6281
Mailing Address - Street 1:501 E PRINCETON DR # 100
Mailing Address - Street 2:P.O. BOX 1391
Mailing Address - City:PRINCETON
Mailing Address - State:TX
Mailing Address - Zip Code:75407
Mailing Address - Country:US
Mailing Address - Phone:972-734-6281
Mailing Address - Fax:972-736-4615
Practice Address - Street 1:501 E PRINCETON DR # 100
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:TX
Practice Address - Zip Code:75407
Practice Address - Country:US
Practice Address - Phone:972-734-6281
Practice Address - Fax:972-736-4615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-29
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146010Medicaid
TX146010Medicaid