Provider Demographics
NPI:1497271308
Name:CALVARY PHARMACY INC
Entity Type:Organization
Organization Name:CALVARY PHARMACY INC
Other - Org Name:CALVARY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILKINSON
Authorized Official - Middle Name:O
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD,RPH
Authorized Official - Phone:972-637-4324
Mailing Address - Street 1:PO BOX 542393
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-2393
Mailing Address - Country:US
Mailing Address - Phone:816-797-3424
Mailing Address - Fax:972-637-4325
Practice Address - Street 1:329 N HIGHWAY 67 STE 150
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-2100
Practice Address - Country:US
Practice Address - Phone:972-637-4324
Practice Address - Fax:972-637-3425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-22
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31556333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy