Provider Demographics
NPI:1235676347
Name:RED DOOR PHARMACY AND GIFTS LLC
Entity Type:Organization
Organization Name:RED DOOR PHARMACY AND GIFTS LLC
Other - Org Name:RED DOOR PHARMACY AND GIFTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIPP
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:817-259-1463
Mailing Address - Street 1:2488 AVONDALE HASLET RD STE 168
Mailing Address - Street 2:
Mailing Address - City:HASLET
Mailing Address - State:TX
Mailing Address - Zip Code:76052-3441
Mailing Address - Country:US
Mailing Address - Phone:903-466-4662
Mailing Address - Fax:817-259-2636
Practice Address - Street 1:2488 AVONDALE HASLET RD STE 168
Practice Address - Street 2:
Practice Address - City:HASLET
Practice Address - State:TX
Practice Address - Zip Code:76052-3220
Practice Address - Country:US
Practice Address - Phone:817-259-2636
Practice Address - Fax:817-259-2636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-26
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX312113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2167423OtherPK