Provider Demographics
NPI:1346692183
Name:EDITH W ACHEBODT
Entity Type:Organization
Organization Name:EDITH W ACHEBODT
Other - Org Name:AJRX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARM D/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:ACHEBODT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-223-5041
Mailing Address - Street 1:1116 W PARKER RD STE 380A
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-2274
Mailing Address - Country:US
Mailing Address - Phone:214-223-5041
Mailing Address - Fax:
Practice Address - Street 1:1116 W PARKER RD STE 380A
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-2274
Practice Address - Country:US
Practice Address - Phone:972-205-9898
Practice Address - Fax:972-205-9888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-05
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30898333600000X, 333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149425Medicaid
2160873OtherPK