Provider Demographics
NPI:1689008377
Name:PHARMACY CARE USA OF ADDISON, LLC
Entity Type:Organization
Organization Name:PHARMACY CARE USA OF ADDISON, LLC
Other - Org Name:PHARMACY CARE USA OF ADDISON, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KENT
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-663-4111
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:HYDRO
Mailing Address - State:OK
Mailing Address - Zip Code:73048-0130
Mailing Address - Country:US
Mailing Address - Phone:405-663-4111
Mailing Address - Fax:405-663-4114
Practice Address - Street 1:4500 RATLIFF LN STE 102
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-3272
Practice Address - Country:US
Practice Address - Phone:972-388-1800
Practice Address - Fax:972-388-1806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX286723336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2141695OtherPK