Provider Demographics
NPI:1346328358
Name:MINYARD FOOD STORES INC.
Entity Type:Organization
Organization Name:MINYARD FOOD STORES INC.
Other - Org Name:SACK 'N SAVE #211
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:BYARS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-393-8700
Mailing Address - Street 1:3451 ALTAMESA BLVD
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-5701
Mailing Address - Country:US
Mailing Address - Phone:817-294-2517
Mailing Address - Fax:817-294-9678
Practice Address - Street 1:3451 ALTAMESA BLVD
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-5701
Practice Address - Country:US
Practice Address - Phone:817-294-2517
Practice Address - Fax:817-294-9678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122783336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4574340OtherNABP ID #
TX462793Medicaid
TX462793Medicaid