Provider Demographics
NPI:1932683513
Name:A T PHARMACY MANAGEMENT, LLC
Entity Type:Organization
Organization Name:A T PHARMACY MANAGEMENT, LLC
Other - Org Name:A T PHARMACY MANAGEMENT LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:682-628-8111
Mailing Address - Street 1:780 NE ALSBURY BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-2641
Mailing Address - Country:US
Mailing Address - Phone:682-628-8111
Mailing Address - Fax:682-206-0211
Practice Address - Street 1:780 NE ALSBURY BLVD STE B
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-2641
Practice Address - Country:US
Practice Address - Phone:682-628-8111
Practice Address - Fax:682-206-0211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-20
Last Update Date:2019-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy