Provider Demographics
NPI:1316204621
Name:MUENSTER PHARMACY
Entity Type:Organization
Organization Name:MUENSTER PHARMACY
Other - Org Name:MUENSTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARION
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-759-6153
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:MUENSTER
Mailing Address - State:TX
Mailing Address - Zip Code:76252-0370
Mailing Address - Country:US
Mailing Address - Phone:940-759-6153
Mailing Address - Fax:940-759-2383
Practice Address - Street 1:511 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:MUENSTER
Practice Address - State:TX
Practice Address - Zip Code:76252-2425
Practice Address - Country:US
Practice Address - Phone:940-759-2833
Practice Address - Fax:940-759-2481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-12
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX240893336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149460Medicaid
5905659OtherNCPDP PROVIDER IDENTIFICATION NUMBER