Provider Demographics
NPI:1639173321
Name:HARVEST DRUG & GIFT LP
Entity Type:Organization
Organization Name:HARVEST DRUG & GIFT LP
Other - Org Name:HARVEST DRUG AND GIFT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEARD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:940-692-7081
Mailing Address - Street 1:4426 KELL BLVD
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76309-4719
Mailing Address - Country:US
Mailing Address - Phone:940-692-7081
Mailing Address - Fax:940-692-9676
Practice Address - Street 1:4426 KELL BLVD
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76309-4719
Practice Address - Country:US
Practice Address - Phone:940-692-7081
Practice Address - Fax:940-692-9676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
TX20613183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151880501Medicaid
TX151880501Medicaid