Provider Demographics
NPI:1235148255
Name:HEALTH AND HUMAN SERVICES COMMISSION
Entity Type:Organization
Organization Name:HEALTH AND HUMAN SERVICES COMMISSION
Other - Org Name:RUSK STATE HOSPITAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST - ACTING PHARMACY DIRECT
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAUGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-683-7093
Mailing Address - Street 1:PO BOX 138
Mailing Address - Street 2:805 NORTH DICKINSON
Mailing Address - City:RUSK
Mailing Address - State:TX
Mailing Address - Zip Code:75785
Mailing Address - Country:US
Mailing Address - Phone:903-683-7170
Mailing Address - Fax:903-683-5996
Practice Address - Street 1:805 N DICKINSON DR # 318
Practice Address - Street 2:
Practice Address - City:RUSK
Practice Address - State:TX
Practice Address - Zip Code:75785
Practice Address - Country:US
Practice Address - Phone:903-683-7170
Practice Address - Fax:903-683-7996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
TX060303336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133331202Medicaid
2097694OtherPK