Provider Demographics
NPI:1316195969
Name:PHARMACY NETWORK
Entity Type:Organization
Organization Name:PHARMACY NETWORK
Other - Org Name:COMMUNITY HEALTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT-CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-324-5400
Mailing Address - Street 1:320 S POLK ST
Mailing Address - Street 2:STE 800
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79101-1426
Mailing Address - Country:US
Mailing Address - Phone:806-324-5400
Mailing Address - Fax:806-324-5495
Practice Address - Street 1:158 BRENTWOOD DR
Practice Address - Street 2:STE 7
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-7994
Practice Address - Country:US
Practice Address - Phone:802-893-1120
Practice Address - Fax:877-899-2622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT03800033953336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4704296OtherNCPDP PROVIDER IDENTIFICATION NUMBER
VT1015558Medicaid