Provider Demographics
NPI:1275771057
Name:PROMETHEUS SERVICES
Entity Type:Organization
Organization Name:PROMETHEUS SERVICES
Other - Org Name:PROMETHEUS SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-262-2421
Mailing Address - Street 1:2636 WALNUT HILL LN
Mailing Address - Street 2:SUITE 335
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-5639
Mailing Address - Country:US
Mailing Address - Phone:214-357-3779
Mailing Address - Fax:
Practice Address - Street 1:2636 WALNUT HILL LN
Practice Address - Street 2:SUITE 335
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75229-5639
Practice Address - Country:US
Practice Address - Phone:214-357-3779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-02
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX263273336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4551253OtherNCPDP PROVIDER IDENTIFICATION NUMBER