Provider Demographics
NPI:1497031447
Name:NUVISION PHARMACY, INC
Entity Type:Organization
Organization Name:NUVISION PHARMACY, INC
Other - Org Name:NUVISION PHARMACY, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:LOYD
Authorized Official - Middle Name:
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-347-4008
Mailing Address - Street 1:4001 MCEWEN RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-5020
Mailing Address - Country:US
Mailing Address - Phone:214-347-4008
Mailing Address - Fax:214-269-0243
Practice Address - Street 1:4001 MCEWEN RD
Practice Address - Street 2:STE 110
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-5020
Practice Address - Country:US
Practice Address - Phone:214-347-4008
Practice Address - Fax:214-269-0243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX274683336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5904253OtherNCPDP PROVIDER IDENTIFICATION NUMBER