Provider Demographics
NPI:1871264648
Name:DAVY CROCKETT DRUG, INC.
Entity Type:Organization
Organization Name:DAVY CROCKETT DRUG, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:936-544-2275
Mailing Address - Street 1:107 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CROCKETT
Mailing Address - State:TX
Mailing Address - Zip Code:75835-2024
Mailing Address - Country:US
Mailing Address - Phone:936-544-2275
Mailing Address - Fax:936-206-7696
Practice Address - Street 1:107 S 4TH ST
Practice Address - Street 2:
Practice Address - City:CROCKETT
Practice Address - State:TX
Practice Address - Zip Code:75835-2024
Practice Address - Country:US
Practice Address - Phone:936-544-2275
Practice Address - Fax:936-206-7696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty