Provider Demographics
NPI:1558739557
Name:IMPULSE PHARMACY INCORPORATED
Entity Type:Organization
Organization Name:IMPULSE PHARMACY INCORPORATED
Other - Org Name:IMPULSE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:TABE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-657-7796
Mailing Address - Street 1:3901 AIRPORT FWY STE 116
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-6117
Mailing Address - Country:US
Mailing Address - Phone:682-200-7869
Mailing Address - Fax:817-484-4222
Practice Address - Street 1:3901 AIRPORT FWY STE 116
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-6117
Practice Address - Country:US
Practice Address - Phone:682-200-7869
Practice Address - Fax:817-484-4222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148051Medicaid