Provider Demographics
NPI:1851846208
Name:CARE FIRST PHARMACY, LLC
Entity Type:Organization
Organization Name:CARE FIRST PHARMACY, LLC
Other - Org Name:CARE FIRST PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:SANDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-617-6059
Mailing Address - Street 1:1910 ROSELAND BLVD SUITE A
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701
Mailing Address - Country:US
Mailing Address - Phone:903-630-2202
Mailing Address - Fax:903-848-2206
Practice Address - Street 1:1910 ROSELAND BLVD A
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701
Practice Address - Country:US
Practice Address - Phone:903-630-2202
Practice Address - Fax:903-848-2206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-15
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X, 3336C0004X
TX313563336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149626Medicaid
2164160OtherPK