Provider Demographics
NPI:1649402652
Name:TARRANT COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:TARRANT COUNTY HOSPITAL DISTRICT
Other - Org Name:TCHD GRAND PRAIRIE COMMUNITY CLINIC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OUTPATIENT PHARMAC
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ABERNATHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-702-6718
Mailing Address - Street 1:2737 SHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-1027
Mailing Address - Country:US
Mailing Address - Phone:817-702-4783
Mailing Address - Fax:817-702-4784
Practice Address - Street 1:2737 SHERMAN ST
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-1027
Practice Address - Country:US
Practice Address - Phone:817-702-4783
Practice Address - Fax:817-702-4784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-10
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4554083OtherNCPDP PROVIDER IDENTIFICATION NUMBER