Provider Demographics
NPI:1740216464
Name:SALFITI SEAGOVILLE PHARMACY, LLC
Entity Type:Organization
Organization Name:SALFITI SEAGOVILLE PHARMACY, LLC
Other - Org Name:GIBSON DISCOUNT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAJA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALFITI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-627-5400
Mailing Address - Street 1:112 HALL RD
Mailing Address - Street 2:
Mailing Address - City:SEAGOVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75159-2916
Mailing Address - Country:US
Mailing Address - Phone:972-287-7070
Mailing Address - Fax:972-287-8199
Practice Address - Street 1:112 HALL RD
Practice Address - Street 2:
Practice Address - City:SEAGOVILLE
Practice Address - State:TX
Practice Address - Zip Code:75159-2916
Practice Address - Country:US
Practice Address - Phone:972-287-7070
Practice Address - Fax:972-287-8199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX189853336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148735Medicaid
2105335OtherPK