Provider Demographics
NPI:1295838332
Name:LEON COUNTY PHARMACY INC
Entity Type:Organization
Organization Name:LEON COUNTY PHARMACY INC
Other - Org Name:CAROLS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER/STORE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LANDON
Authorized Official - Middle Name:RILEY
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:903-536-7326
Mailing Address - Street 1:PO BOX 535
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75833-0535
Mailing Address - Country:US
Mailing Address - Phone:903-536-7326
Mailing Address - Fax:903-536-1206
Practice Address - Street 1:316 S COMMERCE ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:TX
Practice Address - Zip Code:75833-3595
Practice Address - Country:US
Practice Address - Phone:903-536-7326
Practice Address - Fax:903-536-1206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX102243336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2103298OtherPK
TX148622Medicaid