Provider Demographics
NPI:1922679562
Name:NORTH TEXAS PHARMACY, LLC
Entity Type:Organization
Organization Name:NORTH TEXAS PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-876-3214
Mailing Address - Street 1:2741 VIRGINIA PKWY STE 800
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-5027
Mailing Address - Country:US
Mailing Address - Phone:972-876-3214
Mailing Address - Fax:972-876-3214
Practice Address - Street 1:2741 VIRGINIA PKWY STE 800
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-5027
Practice Address - Country:US
Practice Address - Phone:972-876-3214
Practice Address - Fax:972-876-3214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX33857OtherSTATE BOARD LICENSE NUMBER