Provider Demographics
NPI:1578078762
Name:HEALTH ONE PHARMACY LLC
Entity Type:Organization
Organization Name:HEALTH ONE PHARMACY LLC
Other - Org Name:HEALTH ONE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:VADOPPARAMBIL
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:214-469-2244
Mailing Address - Street 1:3800 MAIN ST SUITE 102
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056
Mailing Address - Country:US
Mailing Address - Phone:214-469-2244
Mailing Address - Fax:844-360-8114
Practice Address - Street 1:3800 MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056-2838
Practice Address - Country:US
Practice Address - Phone:214-469-2244
Practice Address - Fax:844-360-8114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-10
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX317423336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2174836OtherPK
TX149787Medicaid