Provider Demographics
NPI:1609810977
Name:TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER
Entity Type:Organization
Organization Name:TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER
Other - Org Name:TTUHSC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEAN, TEXAS TECH SCHOOL OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:M
Authorized Official - Last Name:KUO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:806-356-4000
Mailing Address - Street 1:3601 4TH ST
Mailing Address - Street 2:#1A150
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79430-0002
Mailing Address - Country:US
Mailing Address - Phone:806-743-3270
Mailing Address - Fax:806-743-3260
Practice Address - Street 1:3601 4TH ST # 1B300
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430
Practice Address - Country:US
Practice Address - Phone:806-743-3270
Practice Address - Fax:806-743-3260
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
TX20678333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX20678OtherSTATE BOARD OF PHARMACY
TX320238Medicaid
TX323026OtherMEDICARE PART B IMMUNIZER
TX323026OtherMEDICARE PART B IMMUNIZER
TX20678OtherSTATE BOARD OF PHARMACY