Provider Demographics
NPI:1235501974
Name:UHS RETAIL PHARMACY LLC
Entity Type:Organization
Organization Name:UHS RETAIL PHARMACY LLC
Other - Org Name:CENTRX PHARMACY AT MISSION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:BSC PHARMACY
Authorized Official - Phone:775-440-7424
Mailing Address - Street 1:2345 E PRATER WAY
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-9600
Mailing Address - Country:US
Mailing Address - Phone:775-432-7907
Mailing Address - Fax:775-343-0102
Practice Address - Street 1:900 E INTERSTATE HIGHWAY 2 STE A
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-5757
Practice Address - Country:US
Practice Address - Phone:956-445-5383
Practice Address - Fax:956-585-0023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-21
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX301333336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2154458OtherPK
TX148014Medicaid