Provider Demographics
NPI:1629511100
Name:UHS RETAIL PHARMACY LLC
Entity Type:Organization
Organization Name:UHS RETAIL PHARMACY LLC
Other - Org Name:CENTRX PHARMACY AT NORTHWEST TEXAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PEMBER
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:610-302-3300
Mailing Address - Street 1:1501 S COULTER ST STE A
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1770
Mailing Address - Country:US
Mailing Address - Phone:806-553-2455
Mailing Address - Fax:806-356-7425
Practice Address - Street 1:1501 S COULTER ST STE A
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1770
Practice Address - Country:US
Practice Address - Phone:806-553-2455
Practice Address - Fax:806-356-7425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-01
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX310923336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2166265OtherPK
TX149558Medicaid