Provider Demographics
NPI:1346653367
Name:TOTAL VEIN PHARMACY
Entity Type:Organization
Organization Name:TOTAL VEIN PHARMACY
Other - Org Name:ALLEREACH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-277-7002
Mailing Address - Street 1:7920 ELMBROOK DR STE 108
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4933
Mailing Address - Country:US
Mailing Address - Phone:888-277-7002
Mailing Address - Fax:972-457-1490
Practice Address - Street 1:7920 ELMBROOK DR STE 108
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4933
Practice Address - Country:US
Practice Address - Phone:888-277-7002
Practice Address - Fax:972-457-1490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-06
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29292333600000X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy