Provider Demographics
NPI:1245587781
Name:TROTTS DRUG
Entity Type:Organization
Organization Name:TROTTS DRUG
Other - Org Name:TROTTS CALL FIELD DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-795-3176
Mailing Address - Street 1:4122 CALL FIELD RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-2517
Mailing Address - Country:US
Mailing Address - Phone:940-692-1234
Mailing Address - Fax:940-691-5455
Practice Address - Street 1:4122 CALL FIELD RD
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-2517
Practice Address - Country:US
Practice Address - Phone:940-692-1234
Practice Address - Fax:940-691-5455
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13379251E00000X
TX13370251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX13370OtherBOARD OF PHARMACY