Provider Demographics
NPI:1851694384
Name:MARKS PHARMACY INCORPORATED
Entity type:Organization
Organization Name:MARKS PHARMACY INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT,PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:
Authorized Official - Last Name:EDAKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-275-1333
Mailing Address - Street 1:8150 BROOKRIVER DR STE 107
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4068
Mailing Address - Country:US
Mailing Address - Phone:469-547-5419
Mailing Address - Fax:469-547-2420
Practice Address - Street 1:8150 BROOKRIVER DR STE 107
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4068
Practice Address - Country:US
Practice Address - Phone:469-547-2419
Practice Address - Fax:469-547-2420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X, 3336S0011X
TX272763336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2127932OtherPK