Provider Demographics
NPI:1922088830
Name:AMARILLO DIAGNOSTIC CLINIC RX INC
Entity Type:Organization
Organization Name:AMARILLO DIAGNOSTIC CLINIC RX INC
Other - Org Name:ADC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PIC
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRITTEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:806-679-0375
Mailing Address - Street 1:PO BOX 10003
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79116-0003
Mailing Address - Country:US
Mailing Address - Phone:806-358-0331
Mailing Address - Fax:806-467-8651
Practice Address - Street 1:6700 W 9TH AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1701
Practice Address - Country:US
Practice Address - Phone:806-358-0331
Practice Address - Fax:806-467-8651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
TX150913336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1438594Medicaid
2100590OtherPK
TX0913782-01Medicaid
TX091378201Medicaid
TX143859Medicaid