Provider Demographics
NPI:1285185249
Name:SALFITI WICHITA FALLS PHARMACY INC.
Entity Type:Organization
Organization Name:SALFITI WICHITA FALLS PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:RAJA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALFITI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-532-6112
Mailing Address - Street 1:1101 W EAGLE DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-3721
Mailing Address - Country:US
Mailing Address - Phone:940-627-5400
Mailing Address - Fax:940-627-0257
Practice Address - Street 1:1013 BROOK AVE
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-5006
Practice Address - Country:US
Practice Address - Phone:940-723-7145
Practice Address - Fax:940-322-7062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-14
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13548333600000X
3336C0004X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2164292OtherPK