Provider Demographics
NPI:1407394992
Name:BSA AMARILLO DIAGNOSTIC CLINIC
Entity Type:Organization
Organization Name:BSA AMARILLO DIAGNOSTIC CLINIC
Other - Org Name:BSA ADC IV PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:PHARMACIST/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:806-358-0331
Mailing Address - Street 1:6700 W 9TH AVE STE C
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1729
Mailing Address - Country:US
Mailing Address - Phone:806-356-5533
Mailing Address - Fax:806-467-8651
Practice Address - Street 1:6700 W 9TH AVE STE C
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1729
Practice Address - Country:US
Practice Address - Phone:806-356-5533
Practice Address - Fax:806-467-8651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-06
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX294303336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy