Provider Demographics
NPI:1467904748
Name:THORNHILL HEALTHCARE INC
Entity Type:Organization
Organization Name:THORNHILL HEALTHCARE INC
Other - Org Name:SHALLOWATER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:THORNHILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-832-0300
Mailing Address - Street 1:600 8TH ST
Mailing Address - Street 2:
Mailing Address - City:SHALLOWATER
Mailing Address - State:TX
Mailing Address - Zip Code:79363-5726
Mailing Address - Country:US
Mailing Address - Phone:806-832-0300
Mailing Address - Fax:806-832-0301
Practice Address - Street 1:600 8TH ST
Practice Address - Street 2:
Practice Address - City:SHALLOWATER
Practice Address - State:TX
Practice Address - Zip Code:79363-5726
Practice Address - Country:US
Practice Address - Phone:806-832-0300
Practice Address - Fax:806-832-0301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-02
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31245333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2166070OtherPK
TX149573Medicaid