Provider Demographics
NPI:1619479557
Name:TXPHARMACISTS LLC
Entity Type:Organization
Organization Name:TXPHARMACISTS LLC
Other - Org Name:FATE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:MR
Authorized Official - First Name:HARI
Authorized Official - Middle Name:KRISHNA
Authorized Official - Last Name:CHINTAPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:305-781-2454
Mailing Address - Street 1:14754 STORY LN
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-1235
Mailing Address - Country:US
Mailing Address - Phone:305-781-2454
Mailing Address - Fax:
Practice Address - Street 1:3600 CONFLANS RD # 210
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-6324
Practice Address - Country:US
Practice Address - Phone:469-340-4030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-07
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX318923336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149757Medicaid