Provider Demographics
NPI:1265866727
Name:CARROLLTON REGIONAL PHARMACY
Entity Type:Organization
Organization Name:CARROLLTON REGIONAL PHARMACY
Other - Org Name:FAMILY PHARMACY #2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIPULBHAI
Authorized Official - Middle Name:
Authorized Official - Last Name:SAKHIYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-896-1777
Mailing Address - Street 1:4323 N JOSEY LN STE 102
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4630
Mailing Address - Country:US
Mailing Address - Phone:694-896-1777
Mailing Address - Fax:469-896-2777
Practice Address - Street 1:4323 N JOSEY LN STE 102
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4630
Practice Address - Country:US
Practice Address - Phone:469-896-1777
Practice Address - Fax:469-896-2777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-02
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150465Medicaid
2144427OtherPK