Provider Demographics
NPI:1790760056
Name:ANDREWS PRESCRIPTION SHOP LLC
Entity Type:Organization
Organization Name:ANDREWS PRESCRIPTION SHOP LLC
Other - Org Name:PRESCRIPTION SHOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:432-523-4861
Mailing Address - Street 1:813 HOSPITAL DR
Mailing Address - Street 2:BOX 876
Mailing Address - City:ANDREWS
Mailing Address - State:TX
Mailing Address - Zip Code:79714-3618
Mailing Address - Country:US
Mailing Address - Phone:432-523-4861
Mailing Address - Fax:432-524-4418
Practice Address - Street 1:813 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:ANDREWS
Practice Address - State:TX
Practice Address - Zip Code:79714-3618
Practice Address - Country:US
Practice Address - Phone:432-523-4861
Practice Address - Fax:432-524-4418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-09
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX276233336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2132124OtherPK
TX148414Medicaid