Provider Demographics
NPI:1568718856
Name:SENIOR CARE PHARMACY OF TEXAS LLC
Entity Type:Organization
Organization Name:SENIOR CARE PHARMACY OF TEXAS LLC
Other - Org Name:SENIOR CARE PHARMACY OF TEXAS, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:888-908-8148
Mailing Address - Street 1:3001 SUMMIT AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-7225
Mailing Address - Country:US
Mailing Address - Phone:888-908-8148
Mailing Address - Fax:855-209-6824
Practice Address - Street 1:3001 SUMMIT AVE STE 200
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-7225
Practice Address - Country:US
Practice Address - Phone:888-908-8148
Practice Address - Fax:855-209-6824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-24
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX283233336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2136185OtherPK