Provider Demographics
NPI:1891856969
Name:PROFESSIONAL PHARMACY II
Entity Type:Organization
Organization Name:PROFESSIONAL PHARMACY II
Other - Org Name:PROFESSIONAL PHARMACY II
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/RPH
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHU
Authorized Official - Suffix:
Authorized Official - Credentials:BSPHARM
Authorized Official - Phone:214-765-9238
Mailing Address - Street 1:2730 N STEMMONS FWY
Mailing Address - Street 2:SUITE 813
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75207-2279
Mailing Address - Country:US
Mailing Address - Phone:214-951-0133
Mailing Address - Fax:214-951-0155
Practice Address - Street 1:1221 W AIRPORT FWY STE 111
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-6296
Practice Address - Country:US
Practice Address - Phone:972-514-1277
Practice Address - Fax:972-514-1365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX224593336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145263Medicaid
2098411OtherPK