Provider Demographics
NPI:1568938355
Name:DEVRON SYSTEM INC
Entity Type:Organization
Organization Name:DEVRON SYSTEM INC
Other - Org Name:SIMPLE RX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LATA
Authorized Official - Middle Name:
Authorized Official - Last Name:NARAWANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-612-4802
Mailing Address - Street 1:711 E LAMAR BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-3854
Mailing Address - Country:US
Mailing Address - Phone:817-612-4802
Mailing Address - Fax:817-612-4804
Practice Address - Street 1:711 E LAMAR BLVD STE 106
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-3854
Practice Address - Country:US
Practice Address - Phone:817-612-4802
Practice Address - Fax:817-612-4804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-18
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX32305OtherTEXAS STATE BOARD OF PHARMACY LICENSE