Provider Demographics
NPI:1295201051
Name:PARIS LLC
Entity Type:Organization
Organization Name:PARIS LLC
Other - Org Name:FATE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:HARI
Authorized Official - Middle Name:KRISHNA
Authorized Official - Last Name:CHINTAPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:305-781-2454
Mailing Address - Street 1:14754 STORY LN
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-1235
Mailing Address - Country:US
Mailing Address - Phone:214-919-2399
Mailing Address - Fax:214-919-2344
Practice Address - Street 1:2409 ALCO AVENUE
Practice Address - Street 2:STE C
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-2614
Practice Address - Country:US
Practice Address - Phone:305-781-2454
Practice Address - Fax:888-965-9306
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARIS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-19
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149930Medicaid
TX32302OtherSTATE BOARD OF PHARMACY