Provider Demographics
NPI:1205033859
Name:NATIONAL PHARMACY OF TEXAS
Entity Type:Organization
Organization Name:NATIONAL PHARMACY OF TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:CANERIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-627-7135
Mailing Address - Street 1:2631 GRAVEL DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76118-6982
Mailing Address - Country:US
Mailing Address - Phone:817-590-0073
Mailing Address - Fax:817-590-2252
Practice Address - Street 1:2631 GRAVEL DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76118-6982
Practice Address - Country:US
Practice Address - Phone:817-590-0073
Practice Address - Fax:817-590-2203
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHARMACY CORPORATION OF AMERICA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-28
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX256063336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5970280001Medicare NSC