Provider Demographics
NPI:1477680775
Name:SOUTHERN METHODIST UNIVERSITY
Entity Type:Organization
Organization Name:SOUTHERN METHODIST UNIVERSITY
Other - Org Name:SMU HEALTHCARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:214-768-2149
Mailing Address - Street 1:PO BOX 750195
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75275-0195
Mailing Address - Country:US
Mailing Address - Phone:214-768-2149
Mailing Address - Fax:214-768-2021
Practice Address - Street 1:6211 BISHOP BLVD
Practice Address - Street 2:STE 115
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205
Practice Address - Country:US
Practice Address - Phone:214-768-2149
Practice Address - Fax:214-768-2021
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN METHODIST UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-27
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0181183500000X
TX1081183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty