Provider Demographics
NPI:1629143433
Name:MINYARD FOOD STORES INC.
Entity Type:Organization
Organization Name:MINYARD FOOD STORES INC.
Other - Org Name:MINYARD PHARMACY #5002
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:BYARS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-393-8700
Mailing Address - Street 1:7777 FOREST LN STE A62
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-6881
Mailing Address - Country:US
Mailing Address - Phone:972-566-5800
Mailing Address - Fax:972-566-5889
Practice Address - Street 1:7777 FOREST LN STE A62
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-6881
Practice Address - Country:US
Practice Address - Phone:972-566-5800
Practice Address - Fax:972-566-5889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210313336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4519762OtherNABP ID#
TX464904Medicaid