Provider Demographics
NPI:1215190053
Name:DOC'S DRUGSTORE OF EASTLAND INC
Entity Type:Organization
Organization Name:DOC'S DRUGSTORE OF EASTLAND INC
Other - Org Name:DOC'S DRUGSTORE OF EASTLAND
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-646-7240
Mailing Address - Street 1:905 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EASTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:76448
Mailing Address - Country:US
Mailing Address - Phone:254-629-1000
Mailing Address - Fax:254-629-1020
Practice Address - Street 1:905 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EASTLAND
Practice Address - State:TX
Practice Address - Zip Code:76448
Practice Address - Country:US
Practice Address - Phone:254-629-1000
Practice Address - Fax:254-629-1020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
183500000X, 333600000X
TX262073336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2116941OtherPK