Provider Demographics
NPI:1235635046
Name:GALACTICAL COMMERCIAL LLC
Entity Type:Organization
Organization Name:GALACTICAL COMMERCIAL LLC
Other - Org Name:INSTANT RX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:JACKY
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:817-502-3777
Mailing Address - Street 1:2651 E BROAD ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3899
Mailing Address - Country:US
Mailing Address - Phone:817-502-3777
Mailing Address - Fax:817-502-3778
Practice Address - Street 1:2651 E BROAD ST STE 101
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3899
Practice Address - Country:US
Practice Address - Phone:817-502-3777
Practice Address - Fax:817-502-3778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-02
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BC3200X, 333600000X, 3336C0004X, 3336C0004X
TX319163336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2176649OtherPK