Provider Demographics
NPI:1831121227
Name:TAHOKA DRUG INC
Entity Type:Organization
Organization Name:TAHOKA DRUG INC
Other - Org Name:TAHOKA DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/AO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-998-4533
Mailing Address - Street 1:PO BOX 1020
Mailing Address - Street 2:
Mailing Address - City:TAHOKA
Mailing Address - State:TX
Mailing Address - Zip Code:79373-1020
Mailing Address - Country:US
Mailing Address - Phone:806-561-4041
Mailing Address - Fax:806-561-4725
Practice Address - Street 1:1610 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TAHOKA
Practice Address - State:TX
Practice Address - Zip Code:79373-5125
Practice Address - Country:US
Practice Address - Phone:806-561-4041
Practice Address - Fax:806-561-4725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX135863336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2096191OtherPK
TX143590Medicaid
TX143590Medicaid