Provider Demographics
NPI:1346354339
Name:C D PHARMACIES INC
Entity Type:Organization
Organization Name:C D PHARMACIES INC
Other - Org Name:CIRCLE DRUG PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:EVERETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-662-0774
Mailing Address - Street 1:3211 ROBINSON DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76706-4409
Mailing Address - Country:US
Mailing Address - Phone:254-662-0774
Mailing Address - Fax:254-662-2690
Practice Address - Street 1:3211 ROBINSON DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76706-4409
Practice Address - Country:US
Practice Address - Phone:254-662-0774
Practice Address - Fax:254-662-2690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX131233336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2096363OtherPK
TX143405Medicaid
1246470001Medicare NSC
1246470001Medicare NSC