Provider Demographics
NPI:1235277849
Name:MIEARS LTC PHARMACY
Entity Type:Organization
Organization Name:MIEARS LTC PHARMACY
Other - Org Name:MIEARS LTC PHARMACY, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MIEARS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:903-737-9546
Mailing Address - Street 1:707 LAMAR AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-4492
Mailing Address - Country:US
Mailing Address - Phone:903-737-9546
Mailing Address - Fax:903-785-5646
Practice Address - Street 1:707 LAMAR AVE
Practice Address - Street 2:SUITE C
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-4492
Practice Address - Country:US
Practice Address - Phone:903-737-9546
Practice Address - Fax:903-785-5646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203173336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4513948OtherNCPDP NUMBER
TX350144Medicaid