Provider Demographics
NPI:1235763277
Name:MACPRINCE PHARMACY INC.
Entity Type:Organization
Organization Name:MACPRINCE PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRINCE
Authorized Official - Middle Name:CHIMEZIE
Authorized Official - Last Name:OGBONNA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:806-626-1079
Mailing Address - Street 1:6080 S HULEN ST STE 320
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-2634
Mailing Address - Country:US
Mailing Address - Phone:682-250-2229
Mailing Address - Fax:682-224-3820
Practice Address - Street 1:6080 S HULEN ST STE 320
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-2634
Practice Address - Country:US
Practice Address - Phone:682-250-2229
Practice Address - Fax:682-224-3820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-28
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150302Medicaid