Provider Demographics
NPI:1326103755
Name:ACORN PHARMACY INC
Entity Type:Organization
Organization Name:ACORN PHARMACY INC
Other - Org Name:ACORN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BINDU
Authorized Official - Middle Name:HIMA
Authorized Official - Last Name:KATURI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-887-0744
Mailing Address - Street 1:5315 ROSS AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-7418
Mailing Address - Country:US
Mailing Address - Phone:214-887-0744
Mailing Address - Fax:214-887-0746
Practice Address - Street 1:5315 ROSS AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-7418
Practice Address - Country:US
Practice Address - Phone:214-887-0744
Practice Address - Fax:214-887-0746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
TX172653336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2106054OtherPK
TX149702Medicaid