Provider Demographics
NPI:1245736297
Name:NO 3 AFFORDABLE PHARMACY LLC
Entity Type:Organization
Organization Name:NO 3 AFFORDABLE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-516-2743
Mailing Address - Street 1:214 W AHLDAG ST
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:TX
Mailing Address - Zip Code:77488-2410
Mailing Address - Country:US
Mailing Address - Phone:979-282-2201
Mailing Address - Fax:979-282-2202
Practice Address - Street 1:214 W AHLDAG ST
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:TX
Practice Address - Zip Code:77488-2410
Practice Address - Country:US
Practice Address - Phone:979-282-2201
Practice Address - Fax:979-282-2202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-30
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0002X
TX319183336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2176660OtherPK