Provider Demographics
NPI:1962472290
Name:T & W PHARMACY INC
Entity Type:Organization
Organization Name:T & W PHARMACY INC
Other - Org Name:DOWNTOWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:R
Authorized Official - Last Name:WARDELL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:940-767-4345
Mailing Address - Street 1:1100 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-4650
Mailing Address - Country:US
Mailing Address - Phone:940-767-4345
Mailing Address - Fax:940-767-1392
Practice Address - Street 1:1100 SCOTT ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4650
Practice Address - Country:US
Practice Address - Phone:940-767-4345
Practice Address - Fax:940-767-1392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5764333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX141982Medicaid
4533762OtherNCPDP