Provider Demographics
NPI:1477008324
Name:EXPRESS TRADE LC
Entity Type:Organization
Organization Name:EXPRESS TRADE LC
Other - Org Name:HEALTHCARE2 PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:YAZID
Authorized Official - Middle Name:KHADER
Authorized Official - Last Name:ATIEH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:864-230-7282
Mailing Address - Street 1:101 LIVINGSTON LOOP
Mailing Address - Street 2:SUITE 1- BLDG C
Mailing Address - City:SANTA TERESA
Mailing Address - State:NM
Mailing Address - Zip Code:88008-9753
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 LIVINGSTON LOOP
Practice Address - Street 2:SUITE 1- BLDG C
Practice Address - City:SANTA TERESA
Practice Address - State:NM
Practice Address - Zip Code:88008-9753
Practice Address - Country:US
Practice Address - Phone:575-915-1538
Practice Address - Fax:575-288-2797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy