Provider Demographics
NPI:1376107698
Name:SKRX LLC
Entity Type:Organization
Organization Name:SKRX LLC
Other - Org Name:TIOGA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANUEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:SEBHATU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-437-3600
Mailing Address - Street 1:201 S RAY ROBERTS PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:TIOGA
Mailing Address - State:TX
Mailing Address - Zip Code:76271-3656
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 S RAY ROBERTS PKWY STE A
Practice Address - Street 2:
Practice Address - City:TIOGA
Practice Address - State:TX
Practice Address - Zip Code:76271-3656
Practice Address - Country:US
Practice Address - Phone:940-437-3600
Practice Address - Fax:940-437-3555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-23
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy