Provider Demographics
NPI:1871636738
Name:TEXAS TECH STUDENT HEALTH PHARMACY
Entity Type:Organization
Organization Name:TEXAS TECH STUDENT HEALTH PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACSIT IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:806-743-2636
Mailing Address - Street 1:1003 FLINT AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79409-0001
Mailing Address - Country:US
Mailing Address - Phone:806-743-2636
Mailing Address - Fax:806-743-4474
Practice Address - Street 1:1003 FLINT AVE.
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79409
Practice Address - Country:US
Practice Address - Phone:806-743-2636
Practice Address - Fax:806-743-4474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX060573336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy