Provider Demographics
NPI:1598407546
Name:TANGLEWOOD PHARMACY INC
Entity Type:Organization
Organization Name:TANGLEWOOD PHARMACY INC
Other - Org Name:TANGLEWOOD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-968-7657
Mailing Address - Street 1:2445 NORTHWEST LOOP STE A
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-1705
Mailing Address - Country:US
Mailing Address - Phone:254-968-7657
Mailing Address - Fax:254-968-0364
Practice Address - Street 1:2445 NORTHWEST LOOP STE A
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-1705
Practice Address - Country:US
Practice Address - Phone:254-968-7657
Practice Address - Fax:254-968-0364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-11
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX086988501Medicaid