Provider Demographics
NPI:1376039594
Name:PARIS APOTHECARY, LLC
Entity Type:Organization
Organization Name:PARIS APOTHECARY, LLC
Other - Org Name:PARIS APOTHECARY LTC
Other - Org Type:Other Name
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-785-4208
Mailing Address - Street 1:707 LAMAR AVE STE B
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-4460
Mailing Address - Country:US
Mailing Address - Phone:903-785-4208
Mailing Address - Fax:
Practice Address - Street 1:707 LAMAR AVE STE B
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-4460
Practice Address - Country:US
Practice Address - Phone:903-785-4208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX256813336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX25681OtherTX STATE BOARD OF PHARMACY LICENSE
TX25681OtherTX STATE BOARD OF PHARMACY LICENSE