Provider Demographics
NPI:1275532350
Name:DYER DRUG STORE, INC
Entity Type:Organization
Organization Name:DYER DRUG STORE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILSON
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:972-782-6262
Mailing Address - Street 1:133 MCKINNEY ST
Mailing Address - Street 2:
Mailing Address - City:FARMERSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75442-2221
Mailing Address - Country:US
Mailing Address - Phone:972-782-6262
Mailing Address - Fax:972-782-7870
Practice Address - Street 1:133 MCKINNEY ST
Practice Address - Street 2:
Practice Address - City:FARMERSVILLE
Practice Address - State:TX
Practice Address - Zip Code:75442-2221
Practice Address - Country:US
Practice Address - Phone:972-782-6262
Practice Address - Fax:972-782-7870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13006333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143367Medicaid
TX1243530001Medicare ID - Type Unspecified