Provider Demographics
NPI:1629720727
Name:PALO DURO PHARMACY OPERATIONS LLC
Entity Type:Organization
Organization Name:PALO DURO PHARMACY OPERATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF LEGAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:DUCHAMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-244-4272
Mailing Address - Street 1:1901 MEDIPARK DR.
Mailing Address - Street 2:BLDG C SUITE 3
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106
Mailing Address - Country:US
Mailing Address - Phone:806-353-1217
Mailing Address - Fax:806-353-1222
Practice Address - Street 1:1901 MEDIPARK DR.
Practice Address - Street 2:BLDG C SUITE 3
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106
Practice Address - Country:US
Practice Address - Phone:806-353-1217
Practice Address - Fax:806-353-1222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy