Provider Demographics
NPI:1972500759
Name:GT VAUGHANS PHARMACY LLC
Entity Type:Organization
Organization Name:GT VAUGHANS PHARMACY LLC
Other - Org Name:HUBBARD CITY DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:STORE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-576-2241
Mailing Address - Street 1:PO BOX 295
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:TX
Mailing Address - Zip Code:76648-0295
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 N MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:HUBBARD
Practice Address - State:TX
Practice Address - Zip Code:76648-2446
Practice Address - Country:US
Practice Address - Phone:254-576-2241
Practice Address - Fax:254-576-2496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX269483336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4523850OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TX6629060001Medicare NSC