Provider Demographics
NPI:1649412214
Name:DIABETRX CARE
Entity Type:Organization
Organization Name:DIABETRX CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:903-783-1131
Mailing Address - Street 1:1055 CLARKSVILLE ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-6097
Mailing Address - Country:US
Mailing Address - Phone:903-783-1131
Mailing Address - Fax:903-783-1186
Practice Address - Street 1:1055 CLARKSVILLE ST
Practice Address - Street 2:SUITE 140
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-6097
Practice Address - Country:US
Practice Address - Phone:903-783-1131
Practice Address - Fax:903-783-1186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-29
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX133V00000X
TX412381835P0018X
207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Multi-Specialty