Provider Demographics
NPI:1205228376
Name:UHS RETAIL PHARMACY, LLC
Entity Type:Organization
Organization Name:UHS RETAIL PHARMACY, LLC
Other - Org Name:CENTRX PHARMACY AT TEXOMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PEMBER
Authorized Official - Suffix:
Authorized Official - Credentials:BSC PHARMACY
Authorized Official - Phone:610-302-3300
Mailing Address - Street 1:5012 S US HIGHWAY 75 STE 140
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-4599
Mailing Address - Country:US
Mailing Address - Phone:903-446-6441
Mailing Address - Fax:903-416-6443
Practice Address - Street 1:5012 S US HIGHWAY 75 STE 140
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-4599
Practice Address - Country:US
Practice Address - Phone:903-327-8808
Practice Address - Fax:903-327-8909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-26
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX297733336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2151980OtherPK
TX148019Medicaid