Provider Demographics
NPI:1558766576
Name:QCP WYLIE LLC
Entity Type:Organization
Organization Name:QCP WYLIE LLC
Other - Org Name:QUALITY CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-442-5333
Mailing Address - Street 1:2300 W FM 544
Mailing Address - Street 2:STE 130
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-4931
Mailing Address - Country:US
Mailing Address - Phone:972-442-5333
Mailing Address - Fax:972-442-5356
Practice Address - Street 1:2300 W FM 544 STE 130
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-4903
Practice Address - Country:US
Practice Address - Phone:972-442-5333
Practice Address - Fax:972-442-5356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-03
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 333600000X
TX297873336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2148600OtherPK
TX29787OtherTEXAS BOARD LICENSE