Provider Demographics
NPI:1467915819
Name:ST. PAUL PHARMACY LLC
Entity Type:Organization
Organization Name:ST. PAUL PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:HOA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:469-268-1879
Mailing Address - Street 1:3307 BELT LINE RD
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-6913
Mailing Address - Country:US
Mailing Address - Phone:469-304-0062
Mailing Address - Fax:
Practice Address - Street 1:3307 BELT LINE RD
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-6913
Practice Address - Country:US
Practice Address - Phone:469-304-0062
Practice Address - Fax:469-304-0063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-11
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX32588OtherTEXAS STATE BOARD OF PHARMACY