Provider Demographics
NPI:1891787875
Name:DIAMOND II DRUG INC.
Entity Type:Organization
Organization Name:DIAMOND II DRUG INC.
Other - Org Name:RAFF AND HALL FAMILY PARK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARUN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:806-744-8477
Mailing Address - Street 1:3404 INTERSTATE 27
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79404-2346
Mailing Address - Country:US
Mailing Address - Phone:806-744-8477
Mailing Address - Fax:806-744-8483
Practice Address - Street 1:3404 INTERSTATE 27
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79404-2346
Practice Address - Country:US
Practice Address - Phone:806-744-8477
Practice Address - Fax:806-744-8483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10828333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142645Medicaid
45-2613-5OtherNCPDP PROVIDER #