Provider Demographics
NPI:1518035344
Name:SLMT INC
Entity Type:Organization
Organization Name:SLMT INC
Other - Org Name:MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-764-2739
Mailing Address - Street 1:PO BOX 1233
Mailing Address - Street 2:
Mailing Address - City:FABENS
Mailing Address - State:TX
Mailing Address - Zip Code:79838-1233
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1420 FABENS STREET
Practice Address - Street 2:STE B
Practice Address - City:FABENS
Practice Address - State:TX
Practice Address - Zip Code:79838
Practice Address - Country:US
Practice Address - Phone:915-764-2739
Practice Address - Fax:915-764-7639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
TX161343336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144175Medicaid
4585622OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TXTPI 068137101Medicaid
TXTPI 068137101Medicaid
4585622OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TXTPI 068137101Medicaid