Provider Demographics
NPI:1417436387
Name:DYER DRUG STORE, INC
Entity Type:Organization
Organization Name:DYER DRUG STORE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:EVANS
Authorized Official - Last Name:HICKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-782-6262
Mailing Address - Street 1:133 MCKINNEY ST
Mailing Address - Street 2:
Mailing Address - City:FARMERSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75442-2221
Mailing Address - Country:US
Mailing Address - Phone:972-782-6262
Mailing Address - Fax:972-782-7870
Practice Address - Street 1:133 MCKINNEY ST
Practice Address - Street 2:
Practice Address - City:FARMERSVILLE
Practice Address - State:TX
Practice Address - Zip Code:75442-2221
Practice Address - Country:US
Practice Address - Phone:972-782-6262
Practice Address - Fax:972-782-7870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-10
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX130063336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy