Provider Demographics
NPI:1497878722
Name:NORTH TEXAS INFUSION AND SPECIALTY PHARMACY, L.L.C.
Entity Type:Organization
Organization Name:NORTH TEXAS INFUSION AND SPECIALTY PHARMACY, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:LEON
Authorized Official - Middle Name:HERCHEL
Authorized Official - Last Name:LOWERY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:214-276-5617
Mailing Address - Street 1:3409 WORTH STREET
Mailing Address - Street 2:SUITE 725
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246
Mailing Address - Country:US
Mailing Address - Phone:214-276-5616
Mailing Address - Fax:214-887-0436
Practice Address - Street 1:3409 WORTH STREET
Practice Address - Street 2:SUITE 725
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246
Practice Address - Country:US
Practice Address - Phone:214-276-5616
Practice Address - Fax:214-887-0436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX256703336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX25670OtherSTATE LICENSE
TXR0155996OtherDPS LICENSE
OK99-1242OtherNON-RESIDENT
OK99-1242OtherNON-RESIDENT