Provider Demographics
NPI:1891443214
Name:JIM CALDWELL
Entity Type:Organization
Organization Name:JIM CALDWELL
Other - Org Name:OWL DRUG STORE, LTC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-214-2087
Mailing Address - Street 1:PO BOX 817
Mailing Address - Street 2:
Mailing Address - City:COLEMAN
Mailing Address - State:TX
Mailing Address - Zip Code:76834-0817
Mailing Address - Country:US
Mailing Address - Phone:325-214-2087
Mailing Address - Fax:
Practice Address - Street 1:312 S COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:COLEMAN
Practice Address - State:TX
Practice Address - Zip Code:76834-4214
Practice Address - Country:US
Practice Address - Phone:325-625-2178
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JIM CALDWELL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-15
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy