Provider Demographics
NPI:1891125530
Name:S & L MEDICAL CENTER PHARMACY INC
Entity Type:Organization
Organization Name:S & L MEDICAL CENTER PHARMACY INC
Other - Org Name:S&J MEDICAL CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAJA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALFITI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-532-6112
Mailing Address - Street 1:1101 W EAGLE DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-3721
Mailing Address - Country:US
Mailing Address - Phone:940-627-5400
Mailing Address - Fax:940-627-0257
Practice Address - Street 1:1101 W EAGLE DR
Practice Address - Street 2:SUITE C
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3721
Practice Address - Country:US
Practice Address - Phone:940-627-5400
Practice Address - Fax:940-627-0257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-16
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
TX288033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146867Medicaid
2142989OtherPK