Provider Demographics
NPI:1225176837
Name:PARIS APOTHECARY, LLC
Entity Type:Organization
Organization Name:PARIS APOTHECARY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGE
Authorized Official - Suffix:
Authorized Official - Credentials:BS, CPHT
Authorized Official - Phone:903-785-4208
Mailing Address - Street 1:707 LAMAR AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-4492
Mailing Address - Country:US
Mailing Address - Phone:903-785-4208
Mailing Address - Fax:903-737-6974
Practice Address - Street 1:707 LAMAR AVE
Practice Address - Street 2:SUITE B
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-4492
Practice Address - Country:US
Practice Address - Phone:903-785-4208
Practice Address - Fax:903-737-6974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-03
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25681332B00000X, 332BP3500X, 332BX2000X, 3336C0003X, 3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148571OtherNEW MEDICAID VENDOR DRUG NUMBER EFF. 2016
TX192581001Medicaid
TX501522OtherBC BS
TX4586876OtherNCPDP
TX750307OtherBC BS
TX145847Medicaid
TX145847Medicaid
TX0355000001Medicare NSC