Provider Demographics
NPI:1598428104
Name:SENIOR HEALTH PHARMACY
Entity Type:Organization
Organization Name:SENIOR HEALTH PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:682-382-2290
Mailing Address - Street 1:2601 GRAVEL DR BLDG 3
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76118-6908
Mailing Address - Country:US
Mailing Address - Phone:877-784-1490
Mailing Address - Fax:
Practice Address - Street 1:2601 GRAVEL DR BLDG 3
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76118-6908
Practice Address - Country:US
Practice Address - Phone:877-784-1490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy