Provider Demographics
NPI:1558828921
Name:WAXAHACHIE PHARMACY LLC
Entity Type:Organization
Organization Name:WAXAHACHIE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MURALIKRISHNA
Authorized Official - Middle Name:
Authorized Official - Last Name:NARRA
Authorized Official - Suffix:
Authorized Official - Credentials:BPHARM
Authorized Official - Phone:603-306-2034
Mailing Address - Street 1:300 BOURLAND RD APT 1524
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-3545
Mailing Address - Country:US
Mailing Address - Phone:603-306-2034
Mailing Address - Fax:
Practice Address - Street 1:401 N HIGHWAY 77 STE 23B
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-1130
Practice Address - Country:US
Practice Address - Phone:214-980-1395
Practice Address - Fax:214-980-1396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy