Provider Demographics
NPI:1609881390
Name:D & S PHARMACY
Entity Type:Organization
Organization Name:D & S PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:G
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:806-383-3377
Mailing Address - Street 1:3500 NE 24TH AVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79107-6920
Mailing Address - Country:US
Mailing Address - Phone:806-383-3377
Mailing Address - Fax:806-383-9618
Practice Address - Street 1:3500 NE 24TH AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79107-6920
Practice Address - Country:US
Practice Address - Phone:806-383-3377
Practice Address - Fax:806-383-9618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110619183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163793604Medicaid
TX163793603Medicaid
TX10619OtherSTATE STORE LICENSE
TX142624Medicaid
TX142624Medicaid
TX0760640002Medicare NSC
TX10619OtherSTATE STORE LICENSE