Provider Demographics
NPI:1689676488
Name:TRI-PHASIC PHARMACY, INC.
Entity Type:Organization
Organization Name:TRI-PHASIC PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AYESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDDIQI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-784-2400
Mailing Address - Street 1:1700 TECH CENTRE PKWY
Mailing Address - Street 2:SUITE #110-A1
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-4405
Mailing Address - Country:US
Mailing Address - Phone:817-784-2400
Mailing Address - Fax:817-676-9147
Practice Address - Street 1:1700 TECH CENTRE PKWY
Practice Address - Street 2:SUITE #110-A1
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-4405
Practice Address - Country:US
Practice Address - Phone:817-784-2400
Practice Address - Fax:817-676-9147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22576333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4537152OtherNCPDP