Provider Demographics
NPI:1427370766
Name:PRIDE PHARMACY - CARLISLE LLC
Entity Type:Organization
Organization Name:PRIDE PHARMACY - CARLISLE LLC
Other - Org Name:OAK LAWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-255-2012
Mailing Address - Street 1:4003 LEMMON AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-3737
Mailing Address - Country:US
Mailing Address - Phone:214-954-7389
Mailing Address - Fax:855-716-7525
Practice Address - Street 1:4003 LEMMON AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-3737
Practice Address - Country:US
Practice Address - Phone:214-954-7389
Practice Address - Fax:855-716-7525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-26
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX268063336C0003X, 3336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146126Medicaid
2124376OtherPK