Provider Demographics
NPI:1891326393
Name:EAGLE PHARMACY
Entity Type:Organization
Organization Name:EAGLE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHNATHON
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:DROBLYN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:903-881-5752
Mailing Address - Street 1:1404 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LINDALE
Mailing Address - State:TX
Mailing Address - Zip Code:75771-6267
Mailing Address - Country:US
Mailing Address - Phone:903-881-5752
Mailing Address - Fax:888-374-1180
Practice Address - Street 1:1404 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LINDALE
Practice Address - State:TX
Practice Address - Zip Code:75771-6267
Practice Address - Country:US
Practice Address - Phone:903-881-5752
Practice Address - Fax:888-374-1180
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAGLE PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148371Medicaid
TX28649OtherSTATE BOARD OF PHARMACY
TX28649OtherSTATE BOARD OF PHARMACY