Provider Demographics
NPI:1225553290
Name:MESQUITE CARE PHARMACY INC.
Entity Type:Organization
Organization Name:MESQUITE CARE PHARMACY INC.
Other - Org Name:CARE X PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:VARGHESE
Authorized Official - Middle Name:
Authorized Official - Last Name:NELLIKUNNATHUTHARA VARKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-285-1444
Mailing Address - Street 1:1111 S IRVING HEIGHTS DR
Mailing Address - Street 2:SUITE # 120
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75060
Mailing Address - Country:US
Mailing Address - Phone:972-285-1444
Mailing Address - Fax:972-285-1414
Practice Address - Street 1:1111 S IRVING HEIGHTS DR
Practice Address - Street 2:SUITE # 120
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75060
Practice Address - Country:US
Practice Address - Phone:972-285-1444
Practice Address - Fax:972-285-1414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149667Medicaid