Provider Demographics
NPI:1568025112
Name:TEXOMA PHARMACY LLC
Entity Type:Organization
Organization Name:TEXOMA PHARMACY LLC
Other - Org Name:TEXOMA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RAVIVARMA
Authorized Official - Middle Name:
Authorized Official - Last Name:DASARRAJU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-556-3925
Mailing Address - Street 1:6505 DOONBEG DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-0383
Mailing Address - Country:US
Mailing Address - Phone:832-439-5325
Mailing Address - Fax:
Practice Address - Street 1:140 W LAMBERTH RD STE A
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-2670
Practice Address - Country:US
Practice Address - Phone:903-771-4995
Practice Address - Fax:903-771-4727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-19
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy