Provider Demographics
NPI:1467968438
Name:MERCY CARE PHARMACY LLC
Entity Type:Organization
Organization Name:MERCY CARE PHARMACY LLC
Other - Org Name:MERCY CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ABEER
Authorized Official - Middle Name:
Authorized Official - Last Name:ASLAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-333-0003
Mailing Address - Street 1:801 ROAD TO SIX FLAGS W
Mailing Address - Street 2:STE 122
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-2616
Mailing Address - Country:US
Mailing Address - Phone:682-276-6502
Mailing Address - Fax:817-549-8534
Practice Address - Street 1:801 ROAD TO SIX FLAGS W STE 122
Practice Address - Street 2:STE 122
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2615
Practice Address - Country:US
Practice Address - Phone:682-276-6502
Practice Address - Fax:817-549-8534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-28
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX317833336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149846Medicaid
2175270OtherPK